PREVIEW:  Translational Medicine Friday

The Economics of an "INCOMPETENT" Mental Health Profession

Val's Take/Conjecture

I was absolutely FURIOUS when Polis started talking about "EFFICIENCY" in one of his STATE OF THE STATES.

I've thought about this a minute and I'm wanting to link STAYING on TOP OF THE RESEARCH in HEALTHCARE with EFFICIENCY.

I do think STATES, ADVOCATES, and Individuals and Families need to be pressuring the FEDERAL GOVERNMENT to up its game when it comes to getting TRANSLATIONAL RESEARCH to CLINICIANS and COMMUNICATING via PUBLIC EDUCATION CAMPAIGNS.

CMS partnered with the National Institute of Mental Health on improving TREATMENT for FIRST EPISODE PSYCHOSIS and I think those kinds of partnerships could go much further.

I think one of the things that we've learned the HARD WAY in EDUCATION --- we can't just keep piling on "DO-GOODER" and "FEEL GOOD" Requirements without thinking through and providing for people to do those things with the TIME & ENERGY allotted.

I'm not a fan of the OUT-OF-NETWORK CLINICIAN STRUCTURE in the PRIVATE SPHERE or the let's pay one top guy a ton of money and everybody else work for peanuts in the PUBLIC MENTAL HEALTH SPHERE.

We're burning our "HELPERS" out in this Society --- they're not all women --- but a lot of them are.
PREVIEW:  Olmstead Law & Order Thursday

The Need to SCREEN for Neuro-Developmental Disorders in the JUSTICE-INVOLVED Population

---while at the same time controlling for UNCONSCIOUS BIAS & Neuro-Developmental Weaknesses in DECISION-MAKERS
Val's Take/Conjecture

Many people with an IQ over 70 and Neuro-Developmental Disorders or Differences of older generations were never identified.

The Prescription was almost always:  TRY HARDER and Executive Functioning Challenges were simply NOT ACCEPTABLE even as the people preaching this often had their own EXECUTIVE FUNCTIONING CHALLENGES .

Hyper-Connected Brains, Ramped Up Stress Responses, Intense Emotions, Fatigue and Irritability are COMMON IN THIS SOCIETY.

We already know that there are a lot of people with "ADHD," "Autism" and "Dyslexia" in the Criminal Justice System.

Further, many people are missed because their presentation is so "BLURRED" --- until the CRISIS hits.



Blood-based DNA methylation signatures in cancer: A systematic review (2022)

DNA Methylation Episignatures in Neurodevelopmental Disorders Associated with Large Structural Copy Number Variants: Clinical Implications (2022)

DNA Methylation and Psychiatric Disorders (2018)

DNA methylation signature as a biomarker of major neuropsychiatric disorders (2021)
PREVIEW:  Translational Justice Monday

World Mental Health Day

Mental Health as a "UNIVERSAL HUMAN RIGHT"

Val's Take

This is a very interesting way to CONCEPTUALIZE -- "MENTAL HEALTH" as a "UNIVERSAL HUMAN RIGHT."

On the one hand, we might say we don't have the KNOWLEDGE to make "MENTAL HEALTH" a "UNIVERSAL HUMAN RIGHT."

On the other hand, I think we are often working "BACKWARD" to solve problems:
  • "BEGINNING WITH THE END IN MIND"

There is TENSION and a NEED for BALANCE between ----
  • The Need for Translational Research and Medicine in "Mental Health" and
  • The practical needs for secure and non-secure placements, housing and intensive services and accommodations
    • There is nothing that is particularly "FAIR" about one's need for those SUPPORTS
    • On the other hand, there are "REASONS" both COMPELLING and BORING for the need for such SUPPORTS.

In some ways, the World Health Organizations aspirational "Mental Health is a Universal Human Right" is the FLIP SIDE of a PRESUMPTION of good or at least adequate "MENTAL HEALTH" in the Criminal Justice System ---
  • when the REALITY does not support a presumption of mental well being for purposes of punishment even if the major issue isn't psychosis (although sometimes it is).
Val's Take

CO's DISABILITY STAKEHOLDER GROUP SMOKE-SCREENS

Another Colorado Disability Stakeholder Group  had its orientation meeting Oct. 3 --- that they are now calling "SITUATIONAL AWARENESS ONLY" --- for Task Force Members.

I and probably many others suspect they will try to do "GOOD THINGS" ---

BUT THEY ARE VERY UNLIKELY TO COMPLY WITH FEDERAL DISABILITY RIGHTS LAW --- specifically Olmstead.

I've not laid into the Polis Administration the way I did the Hickenlooper Administration ---
  • mainly because I really had a lot of "FAITH" in the Hickenlooper Administration ---
    • and I got let down in a big way


I wasn't quite so naive for any subsequent administration --- there's been a lot of "TALK" about Olmstead in the Polis Administration ---
  • but very little real commitment to compliance

I don't see this STAKEHOLDER GROUP as a substitute for what I am proposing with regard to SUPPORTIVE HOUSING:
  • Measurable Goals
  • Reasonable Time Frames
  • Proposals to Fund the Plan

In Minnesota's Jensen Case, the Judge was beside himself in FRUSTRATION with the STATE as it did everything but actually comply with the LAW.

That is certainly a FRUSTRATION I feel with respect to Colorado.

Federal District Judge Donovan Frank (Minnesota)
PREVIEW:  Translational Medicine Friday

More on Stroke & ADHD

  • Sleep Disturbance
  • Migraine
  • Periodontal Disease

Stroke and Mini-Stroke are associated with PSYCHIATRIC DISORDERS

Val's Take/Conjecture

  • Addressing underlying causes of:
    • Sleep Disturbance
    • Migraine, and
    • Periodontal Disease

Could probably go along way to improving mental health of the population.

SLEEP DISTURBANCE
  • this could be insomnia, this could be sleep apnea
  • It is very important that we get enough OXYGEN to the brain --- and that may be and probably is even more true at ALTITUDE.
  • National Jewish Hospital in Denver is a National Resource and they are SLEEP EXPERTS.
    • They and others could be much more a part of INTEGRATED CARE.



MIGRAINE
  • I had Migraines for probably 4 or 5 years before an extremely dangerous psychotic episode in 2006.
  • A mini-stroke may have been in the mix --- since vision issues were also included and I was experiencing "seeing lights"--
  • Maybe not that surprisingly, it's really taken a lot for us to put together the knowledge we do have on:
    • Neuro-Developmental Differences involving among other things Maternal Immune Activation
    • Physical Health Issues
    • Mental Health Issues, and
    • Dental Health Issues

DENTAL HEALTH

I don't  necessarily think it is any accident that DENTISTS OFFICES have some of the best "REMINDER" SYSTEMS out there.
  • Many mental health providers could learn a lot from them.
  • On the other hand, many people don't realize how important dental health is to their physical and mental health.
  • Some people may have genetic vulnerabilities. 
  • In addition, Sugar and Caffeinated Sodas (Diet or Otherwise) are often a go-to for people experiencing low grade fatigue.

'Mini-strokes' lead to PTSD and other psychiatric disorders

PREVIEW:  Olmstead Law & Order Thursday

Draft State Supportive Housing Olmstead Planning Bill

Val's Take

Nebraska Olmstead Planning Bill
https://orchidadvocacy.org/nebraska-olmstead-plan-statute.html

This is very much a draft and it is focused on:
  • Housing
    • Scattered Site
    • Medicaid Certified Alternative Care Facilities (Assisted Living Residences),
    • others?
  • Medicaid Supportive Services that would be available as needed in conjunction with the Housing

US Dept. of Justice Background on Some of the Concepts in the Draft CO Olmstead Supportive Housing Bill.

Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.


Question #7:  " A state’s obligations under the ADA are independent from the requirements of the Medicaid program." --- this is important with regard to the State's obligations to provide Housing which is not covered by Medicaid. Further, many DOJ Olmstead Settlement Agreements include provisions for Housing.

Question #12:  "The plan must have specific and reasonable timeframes and measurable goals for which the public entity may be held accountable, and there must be funding to support the plan, which may come from reallocating existing service dollars."

[The PROBLEM for States is De-Institutionalization over the past 50 or 60 years --- they stopped funding bed space and they never adequately funded Community Mental Health because they "THOUGHT" psychotropic medications were going to solve the problems and for some people psychotropic medications have helped enormously.

Further, a lot of the "COST" of caring for folks under MANAGED CARE got COST-SHIFTED to the JUSTICE SYSTEM and MUNICIPALITIES and COUNTIES.

So Now it is not very easy for STATES to Re-Allocate funds that often aren't coming out of their budgets --- but out of the budgets of MUNICIPALITIES, COUNTIES and others.

Further, the 21st Century conceptualizations of Neuro-Developmental / Psychiatric Continuum and "Executive Functioning Problems" and an idiosyncratic ENERGY SUPPLY / Fatigue --- have complicated the Treatment Landscape.

On the other hand, those new conceptualizations are also bringing HOPE --- If we don't push ourselves and others, beyond our and their LIMITS and allow people to develop the "GIFTS" --- they do have --- things can often be "BETTER."]

2010 DOJ Settlement Agreement with the State of Georgia regarding inmates with mental illness being released from incarceration.
  • I point this out because the DOJ Statement above doesn't reference Criminal Justice --- BUT Olmstead has been used in that context.

Remarks as Prepared for Delivery by Assistant Attorney General for the Civil Rights Division Regarding the State of Georgia's Mental Health and Developmental Disability System

"In addition, also by July 1, 2015, Georgia has agreed to provide services in community settings for 9,000 individuals with mental illness who currently receive services in the state hospitals, are frequently readmitted to state hospitals, are frequently seen in emergency rooms, are chronically homeless or are being released from jails or prisons."



The 1/5 figure for participation of people with lived experience is taken from a DOJ Settlement Agreement with Oregon.
2016 Oregon Performance Plan for Mental Health Services for Adults with Serious and Persistent Mental Illness

2. OHA will maintain a system for accountability for the performance outcomes specified in Section D of this Plan, by including the following elements of OHA's USDOJ Project governance structure:

a.  USDOJ Agreement Stakeholder Advisory Team: composed of a cross section of  diverse stakeholders, including a minimum of 20% individuals with lived experience, to review and comment on the progress towards and performance of the outcomes specified in Section D and provide advice to OHA regarding the strategies being employed."
I don't think an "Olmstead Planning Bill" is the ONLY way to address significant SHORTAGES in SUPPORTIVE HOUSING for people with Physical and Cognitive Disabilities who are:
  • INSTITUTIONALIZED
  • At Risk of Institutionalization, and
  • Needing LONG TERM CARE ---

BUT if States are supposed to be complying with the ADA, Title II and the Olmstead decision anyway --- why not.
A LITTLE SECRET

If we change some of the "VARIABLES" such as:
  • Better access for Individuals, Families, Educators & Employers to
    • ACCOMMODATIONS [askjan.org ]
    • For Employers especially, we need to INCENTIVIZE taking on the LEARNING CURVE of working with EXECUTIVE FUNCTIONING DIFFERENCES.
  • And MORE TIMELY ACCESS to Translational Research and Medicine --- the need for SUPPORTIVE HOUSING could come down.

Improving access to ACCOMMODATIONS and TRANSLATIONAL RESEARCH likely would reduce the need for SUPPORTIVE HOUSING for People with Disabilities.


IN THE MEANTIME
  • Lack of SUPPORTIVE HOUSING is not only a BIG PHYSICAL, EMOTIONAL and FINANCIAL BURDEN to Individuals:
    • It is also a BIG BURDEN to:
      • Municipalities
      • Businesses,
      • Counties, and
      • Law Enforcement

IS IT POSSIBLE TO MAKE THINGS WORSE? Yes, It Is.
  • "TRY HARDER" and "NEURO-PLASTICITY" if not well understood --- CAN BE A DISASTER
  • Many people on the Neuro-Developmental/Psychiatric Continuum ALREADY HAVE "HYPER-CONNECTED" BRAINS
  • People who are ACTUALLY GOING TO USE THIS "SUPPORTIVE HOUSING" need to be part of the process of CO-CREATING IT.

The Public Needs to be Educated About WHY People Need SUPPORTIVE HOUSING
  • LAW ENFORCEMENT might be very persuasive to community members who are SKEPTICAL.
Preview:  Neuro-Diversity Wednesday

Neuro-Diverse people are some of the "SMARTEST" (not perfect people) on the planet

BUT there are commonalities with traditional "Intellectual Disabilities" like "DOWN SYNDROME" --
  • What is going on?
My aunt was probably 4'6," she had struggled with her weight all her life and in school --- at least one teacher did think she had DOWN SYNDROME. (Obesity as a suspect class)

She had a very hard life and she faced a lot of discrimination and it was focused primarily on her weight and there were not a lot of legal protections and their still aren't.

Her "IQ" was at least average and probably above average --- she ultimately became an artist.
My maternal grandfather was short and stocky even though he came from a family of tall people and the tall mother may have had some mental health problems -- at least my grandfather told my grandmother never to leave my mom or my aunt alone with my great grandmother.

My maternal grandfather had some alcohol problems and ultimately "abandoned" my grandmother with polio and the 2 kids ---
  • but the truth may have been that he couldn't take care of himself much less anyone else.

My aunt, my mother, 2 of my cousins and myself are very short and relatively stocky girls.

One of my cousins who was a non-identical fraternal twin girl of one of the cousins and of more average height.  She died of multiple health problems in her 40s.  Her weight fluctuated wildly from the time she was a child and very thin to her ultimate death.

METABOLISM is something that is being DYSREGULATED, and while DIET and EXERCISE are important --- it is taking some people a lot more to REGULATE and for more and more modern people --- it is taking more time to regulate than it would have for the majority of people a few decades ago.

Of course there were always some people who struggled with their weight. In fact, my maternal tall grandmother stuggled with her weight and she was growing up in the early part of the 20th century and the 1920s.  
During my pregnancy with my son, some of the tests came back that my son had a 5% chance of having DOWN SYNDROME.

My son does not have DOWN SYNDROME --- He's "GIFTED" (which is a mixed blessing), a PERSONAL TRAINER and can deadlift 455 pounds.
For a lot of COMPLEX MEDICAL PROBLEMS --- we can often be talking about "MULTIPLE DYSREGULATIONS of the BODY."

The ULTIMATE COMPLEX MEDICAL PROBLEM is MORTALITY in which MULTIPLE SYSTEMS of the BODY start to fail and ---
  • the Catch 22s near death as the result of chronic illness are more obvious --- at least in modern times ---
    • For example, do you really want to resusitate that person near death if you have to break their ribs to do it.
    • On the other hand, see Not Dead Yet -- The Resistance.
I think "Genes," and "Trauma" are in the vernacular and "Epigenetics" is getting there.

Some other terms  that may be on the horizon are "DNA MYTHLATION SIGNATURES" as well as "RNA MYTHLATION SIGNATURES"
DNA methylation signature as a biomarker of major neuropsychiatric disorders
Principles of RNA methylation and their implications for biology and medicine
RNA:  ribonucleic acid, a nucleic acid present in all living cells. Its principal role is to act as a messenger carrying instructions from DNA for controlling the synthesis of proteins, although in some viruses RNA rather than DNA carries the genetic information.

-- Oxford Languages
Methylation: An Ineluctable Biochemical and Physiological Process Essential to the Transmission of Life
  1. www.nature.com › articles › s41467/022/33511-6
    The immune factors driving DNA methylation variation ... - Nature     (2022)
So what I'm trying to get at is that there are some very complicated common drivers of:
  • Neuro-Developmental Disorders
  • Neuro-Psychiatric Disorders
  • Auto Immune Diseases, and
  • Cancer
  • Etc.

As we better understand the role of the Immune System in each of these categories --- it will likely spill over to better understandings of the other categories as well.

Additionally, it may alter our ideas around "INTELLIGENCE" and show a relationship to the "IMMUNE SYSTEM."

High intelligence: A risk factor for psychological and physiological overexcitabilities
Specifically, those with a high intellectual capacity (hyper brain) possess overexcitabilities in various domains that may predispose them to certain psychological disorders as well as physiological conditions involving elevated sensory, and altered immune and inflammatory responses (hyper body)
Linda Crnic Institute for Down Syndrome --- CU Medicine

Down Syndrome is an Immune Disorder
www.amazon.comdown syndrome facts - Instant Access w/ Kindle

DENVER – A groundbreaking new study conducted by the Crnic Institute for Down Syndrome shows definitively that Down syndrome can be categorized as an immune system disorder, based on analyses of thousands of proteins found in blood samples.
Philosophy of Immunology @ Stanford Encyclopedia of Philosophy

[I'd never heard of "Philosophy of Immunology" before and it does seem in contrast to Cartesian Mind/Body Dualism.

I think "Immunology" is having a moment and it's clear the Immune System is doing a lot more than what we thought and is having profound impacts not only on the "Body" but also on the "Mind" and by extension on "Philosophy of Mind and Body."]
Like a lot of "lay people" --- I thought the Mental Health Profession was on much more solid intellectual ground than they ACTUALLY are.

It took a lot of courage for former Director of the National Institute of Mental Health Thomas Insel to declare in 2013 that the DSM 5 "lacked validity."

Okay --- Well, what do you do next?  If you're the National Institute of Mental Health --- you begin the Research Domain Criteria Program (RDoC).

At the same time that we're recognizing that the DSM 5 "lacks validity" we're recognizing:
  • the biological basis of behavior
  • the biological effects of our social environments
  • the biological effects of our physical environments
  • very complex interactions of multiple systems of the body, some of which aren't even human --- think the Microbiome

BUT what if you're the Criminal Justice System --- this is beyond INCONVENIENT and do you really have the SWAY to up-end long-standing legal understandings.

IT WOULD BE SO MUCH BETTER --- If the POLITICAL PROCESS could build out a PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE that was inclusive of:
  • justice-involved people
  • business owners
  • law enforcement
  • families
  • professionals
  • etc.
PREVIEW:  Translational Justice Monday

Neuro-Diversity and Accommodations

Beyond Executive Functioning to Idiosyncratic Energy Management

Val's Take/Conjecture
  • I think Neuro-Diverse people can look both "HYPER" and "LETHARGIC"
    • Trying to Understand both COMMON and IDIOSYNCRATIC ENERGY ISSUES for Neuro-Diverse people is important
      • It is one of the keys to managing EXECUTIVE FUNCTIONING ISSUES
        • This is "TRY SMARTER" not "HARDER."
"The harder I tried actually the worse I started doing --- because I was already at capacity.

"The result of this message of 'TRY HARDER' was the worse grades and I thought less of myself."
The first step may be just recognizing that "FATIGUE" can be an ISSUE ---
  • that can be very hard if there is no obvious physical disability.

I think one of the culprits (not necessarily the only one) in FATIGUE is C-Reactive Protein (See Mayo Clinic on C-Reactive Protein Test)


C-Reactive Protein is associated with INFLAMMATION and HEART DISEASE.

C-Reactive Protein is also associated with Neuro-Developmental Disorders and Psychiatric Disorders.


Eur Child Adolesc Psychiatry. 2020 Feb;29(2):239-247.
doi: 10.1007/s00787-019-01372-y. Epub 2019 Jul 16.

Maternal serum C-reactive protein (CRP) and offspring attention deficit hyperactivity disorder (ADHD)


www.frontiersin.org › articles › 10
Frontiers |

Biomarkers, Inflammation, and Bipolar Disorder ...

  • Scientific evidence has found a correlation between high levels of C-reactive protein and manic states, while more uncertain data are those concerning euthymic and depressive states (19), although some studies show the increase, decrease or absence of variations of CRP during the various phases of the disease (14).

Is C-reactive protein a biomarker of systemic inflammation?

  • Fatigue is highly prevalent and causes serious disruption in quality of life. Although the underlying biological mechanism is unknown, increases in inflammation have been implicated. This prospective study examined the association between C-reactive protein (CRP), a biomarker of systemic inflammation, and fatigue five years later.

Prospective Association between C-Reactive Protein and Fatigue in the Coronary Artery Risk Development in Young Adults Study

www.ncbi.nlm.nih.gov/pmc/articles/PMC2763037/


C-reactive protein: an activator of innate immunity and a modulator of adaptive immunity (2004)

Cognitive and Social Abilities rely on a Delicate Balance of Innate & Adaptive Immunity (2019)
So to me this is a JUSTICE ISSUE --- this is a LEGAL ACCOMMODATION ISSUE.

It is also helps explain why our current MENTAL HEALTH PROFESSION is not really getting the RESULTS we need.

If you think this is a question of MOTIVATIONAL INTERVIEWING and you're really dealing with SYSTEMIC DEVELOPMENTAL INFLAMMATION and the RAMIFICATIONS of that ---
  • that's a BIG MISS.

State and Federal Governments are paying enormous sums of money for Mental Health and individuals and families are often being asked to pay out of network for providers who don't take insurance --
  • I think Mental Health treatment can be life-saving ---
  • BUT we're having ALL THESE CRISES because some of the fundamental conceptualizations of the last few decades are WRONG.
PREVIEW:  Translational Medicine Friday

The Biology of Trans-Sexuality

Conjecture

I don't know that there is "ONE BIOLOGY" that explains all of Trans-Sexuality and I wouldn't necessarily exclude some idea of "SOCIAL CONTAGION" or "SUGGESTION" as a factor for some people ---

THAT IS WHY YOU REALLY WANT THE BIOMARKERS.

The reason I say that is people are looking for VOCABULARIES to explain their INDIVIDUAL EXPERIENCES.

Homosexual is now LESBIAN, GAY, BISEXUAL, Trans-Sexual, Asexual . . . ETC.

BUT

with TRANS-SEXUALITY you're talking about something that is perceived not only UNDESIREABLY by the SOCIETY but also by the PERSON --
  • albeit sometimes in different ways.

For at least some people there are clear biomarkers.
Stanford's Robert Sapolsky on the Neuro-Biology of Trans-Sexuality
I think this "IDEA" that there is this neat division of somebody who just is "IN THE WRONG BODY" --- is starting to give way in some cases to something that is MORE COMPLEX.

There seem to be "DYSREGULATIONS OF MULTIPLE SYSTEMS OF THE BODY" ---- and that is why trying to address them can be very, very COMPLICATED.

And also why "TRANSITIONING" might work for one person but not for somebody else.
To me, the "TRANSITIONING CONVERSATION" is not unlike the "PSYCHIATRIC MEDICATION CONVERSATION" ---
  • It can be very SIMPLISTIC
I think NEURO-DIVERSITY is on many, many dimensions --- not just gender or sexual orientation --- and it is coming in many combinations.
What is Neurodiversity?
New Hope Church:  Don't Put People in Boxes
PREVIEW:  Translational Justice Monday

Executive Functioning Differences, Idiosyncratic Energy Issues and ---

OCCUPATIONAL THERAPY
This is a video from Canada on Flexible Assertive Community Treatment -- the page below is trending on the Orchid website.

One of the interesting things about this video is that an Occupational Therapist is part of the Flexible Assertive Community Treatment Team.

Additionally, see our page "Mental Health Courts Pro & Con" ---  the TedTalk on Mental Health Courts is presented by a Judge who is also an OCCUPATIONAL THERAPIST.
Val's Take/Conjecture

I think Occupational Therapy has some experience in dealing with ADHD -- maybe more with Children than Adults --- but somebody has thought to put OCCUPATIONAL THERAPISTS on a Assertive Community Treatment Team.

From my perspective, OCCUPATIONAL THERAPY & "REASONABLE ACCOMMODTIONS" are the CRITICAL PIECES that can make the difference between SURVIVING and THRIVING.

By the time the "CRISIS" hits --- there are often many things that ARE NOT WORKING in relation to the person's ABILITIES, CHALLENGES, and what the person, others, and the society are EXPECTING as "REASONABLE."

When there is a BIG ASYNCHRONOUS MIS-MATCH --- that is setting the stage for a MELT-DOWN, BURNOUT or BREAK-DOWN.

Further, there is a lot of UNCONSCIOUS BIAS in all of this --- if someone in a position of authority has a MELTDOWN ---
  • Everybody's just supposed to SUCK IT UP.
    • But that is not really good for the person or the people around them.
      • There are a lot of human beings trying to EMOTIONALLY REGULATE on the BACKS OF OTHER PEOPLE.
        • That is one of the things that is so challenging about dealing with any form of DISCRIMINATION ---
          • There is a huge impetus to try and find some other group --- TO GO OFF ON.
            • Surely we can do that when it comes to the "BAD PEOPLE."
            • The inconvenient facts are there are often PUBLIC HEALTH EXPLANATIONS for the "BAD BEHAVIOR" of the "BAD PEOPLE."
              • We can't ignore bad behavior --- but if it's a "BRAIN INJURY" and/or some other complicated cognitive neuro-developmental/psychiatric issue --- we need to be HONEST about that --- and address it accordingly.
                • To me that gets us out of arbitrary sentences --- and should be forcing us to address root causes and safety more directly.
PREVIEW:  Neuro-Diversity Wednesday

Leonardo da Vinci and Uncompleted Projects

Beyond the Conventional Wisdom
Did Leonardo da Vinci have ADHD?

Date:  May 23, 2019

Source:  King's College London

Summary:

Leonardo da Vinci produced some of the world's most iconic art, but historical accounts show that he struggled to complete his works. New research now suggests the best explanation for Leonardo's inability to finish projects is that the great artist may have had attention deficit and hyperactivity disorder (ADHD).
Picture
Mortimer Adler -- American Philosopher and one of the founders of the Great Books Program


Adler put a premium on "DIALOGUE" --- not unlike even ancient philosophers --- but he was able to articulate that and write about it more directly than Socrates (who didn't write anything) and Plato (whose "Dialogues" were works of art in their own way).

Adler's idea of the "GREAT CONVERSATION" is a CONVERSATION that spans GENERATIONS.
Val's Take/Conjecture
  • Some of the commentaries even by ADHD Experts that have ADHD bemoan the fact that Leonardo da Vinci --- didn't complete all the projects they think he should have.
  • OMG! This is Leonardo "F'in' " da Vinci
    • if you can't get it for Leonardo da Vinci ---
      • what hope is there for the rest of us?
 
  • So I think Leonardo was trying to "LEARN" as much as he could in the brief amount of time that he had (although he had a long life by common standards)
    • further he was crossing many disciplines AND
    • ultimately he viewed everything as CONNECTED.
    • I think there is a TENSION in "LEARNING" --- to go as far as you PERSONALLY can go --- and to COMMUNICATE that to others.
 
  • Additionally, the "IDEA" of a "FINISHED PRODUCT" can be somewhat ILLUSORY in that most things are subject to REVISION and at the very least RE-INTERPRETATION.
    • even our own lives.
    • it is quite humbling to think that FUTURE GENERATIONS may very well have a better understanding (in some respects) of what is going on NOW --- than we do.
 
  • BUT those FUTURE GENERATIONS are DEPENDENT on US ---
    • So like Arjuna in the Bhagavad Gita --- we must "fight on" in our own ways.
PREVIEW:  Neuro-Diversity Wednesday

The role of DNA methylation in progression of neurological disorders and neurodegenerative diseases as well as the prospect of using DNA methylation inhibitors as therapeutic agents for such disorders (2023)

Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis (2022)

Affiliations
  • 1 Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • 2 Department of Medicine, University of Valencia/INCLIVA Health Research Institute and Centro de Investigación en Red de Salud Mental (CIBERSAM), Valencia, Spain.
  • 3 Department of Health Planning and Economics, National School of Public Health, Institute of Health Carlos III, Madrid, Spain.
  • 4 School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
  • 5 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
  • 6 Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
  • 7 Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • 8 Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
  • 9 Instituto Aragonés de Ciencias de la Salud, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Zaragoza, Spain.
  • 10 Department of History of Science and Documentation, University of Valencia, Valencia, Spain.
  • 11 Unidad de Información e Investigación Social y Sanitaria, University of Valencia, Spanish National Research Council, Valencia, Spain.
  • 12 Life Sciences Department, Barcelona Supercomputing Center, Barcelona, Spain.

Conclusions and relevance:

This systematic review and meta-analysis found that ASD and ADHD are associated with a significantly increased risk of mortality.

Understanding the mechanisms of these associations may lead to targeted strategies to prevent avoidable deaths in high-risk groups. The substantial heterogeneity between studies should be explored further.


Placental DNA methylation profile as predicting marker for autism spectrum disorder (ASD) (2023)

Ravaei A, Emanuele M, Nazzaro G, Fadiga L, Rubini M. Mol Med. 2023 Jan
16;29(1):8. doi: 10.1186/s10020-022-00593-3. PMID: 36647002 Free PMC article. Review.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impairs normal brain development and socio-cognitive abilities. ...In addition, non-genic DMRs in ASD-placenta proposes an alternative contributing mechanism for ASD development. Our study h …
DNA methylation associated with persistent ADHD suggests TARBP1 as novel candidate (2020)
Weiß AL, Meijer M, Budeus B, Pauper M, Hakobjan M, Groothuismink J, Shi Y, Neveling K, Buitelaar JK, Hoogman M, Franke B, Klein M. Neuropharmacology. 2021 Feb 15;184:108370. doi: 10.1016/j.neuropharm.2020.108370. Epub 2020 Oct 31. PMID: 33137342 Free article.
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by age-inappropriate symptoms of inattention and/or hyperactivity and impulsivity. ...DNA methylation of single sites with …
Methylation
National Human Genome Research Institute

"Methylation is a chemical modification of DNA and other molecules that may be retained as cells divide to make more cells.

"When found in DNA, methylation can alter gene expression.

"In this process, chemical tags called methyl groups attach to a particular location within DNA where they turn a gene on or off, thereby regulating the production of proteins that the gene encodes."
Epigenetic Mechanisms in Psychiatric Disorders

Mar 3, 2021 · There is increasing evidence that epigenetics may play a role in the pathophysiology of psychiatric disorders such as major depressive disorder, psychosis and addiction.

The Epigenetics of Anxiety Pathophysiology: A DNA Methylation and Histone Modification Focused Review.  (2023)

Anxiety is one of the most common psychiatric disorders diagnosed in the United States today.

Like all mental illnesses, anxiety pathology includes genetic, molecular, somatic, and behavioral characteristics. ...Furthermore, there have been studies showing th …

A DNA methylation signature discriminates between excellent and non-response to lithium in patients with bipolar disorder type 1 (2020)
PREVIEW:  Translational Medicine Friday
MC Hammer
U Can't Touch This
J Cole -- a m a r i
getting out of your ASSIGNED SEAT
Val's Take/Conjecture
  • before we spend another TRILLION DOLLARS or whatever it is that we are spending on MENTAL HEALTH CARE in this Country
    • We need to get CLEAR or at least CLEARER on what we're paying for.
 
  • There are "ACCESS" issues in "MENTAL HEALTH" --- those aren't the only issues
 
  • If I see another "psychological" video with the word "NARCISSISM" in it --- I may scream
    • BUT if you don't have the BIOMARKERS -- I think that is what CLINICIANS are sometimes left with.
    • these sort of vague, pejorative analyses -- with the "PERSONALITY DISORDERS" serving as a kind of "CATCH-ALL"
 
  • I do think the "EXPERIENCE" of NEURO-DIVERSE people with IDIOSYNCRATIC SENSORY PROCESSING, which is often related to IDIOSYNCRATIC ENERGY
    • can be a PRETTY WILD RIDE
 
  • If you are taking in MORE SENSORY INFORMATION --- You probably are going to PICK UP MORE PATTERNS --
    • Nobody's picking up everything.
 
  • I think some NEURO-DIVERSE people do have the "EXPERIENCE" that in one or more respects they have a "TALENT" or an "INSIGHT" that is not widely shared by the "MAJORITY"
 
  • One of the things that recently Black Musicians have been pointing out is that much of this "musical ability" is really about "MATH" --- that we tend to associate with "SMART PEOPLE."


On the other hand, you can be more subject to MELTDOWNS, BURNOUTS and BREAKDOWNS --
  • If you don't manage an ATYPICAL ENERGY SUPPLY

I do think Neuro-Diverse people have to "GET OUT OF THEIR ASSIGNED SEAT" if they are going to take care of themselves ---
  • that is difficult when your needs are falling into somebody's category of "THAT'S NOT REASONABLE."

I think when people understand that these SENSORY PROCESSING DIFFERENCES are bringing a LOT OF INTENSITY that takes SIGNIFICANTLY MORE TIME TO MANAGE ---
  • That is at least STARTING to make some of this a little more understandable.

Also, by and large-- this isn't the NEURO-DIVERSE PEOPLE vs. the NEURO-TYPICALS --
  • It's a lot of Neuro-Diverse People (but not necessarily in the same respect)
  • and Some in more STRESSFUL, UNWELCOMING ENVIRONMENTS than others.

Additionally, Neuro-Diversity is really about "falling outside the norm" in some respect ---
  • maybe that's HYPER-ACTIVITY,
  • maybe it's LOW ENERGY and THYROID ISSUES
  • maybe you're dyslexic --
  • maybe you're hyper-lexic --- significantly higher word coding ability
  • BUT "OPPOSITES" on those SPECTRUMS giving each other a little MERCY and GRACE
    • I think absolutely can help others.
 
  • I do think the LGBTQ+ contingent of the Neuro-Diverse Community is helping other Neuro-Diverse Folks come out of the closet (especially, if their masking was so good -- they didn't even know they were in the closet).
    • who might be falling outside the majority with regard to other issues. 


BBC:  Demystifying Autism and Over-Stimulation
So part of what I'm trying to say with regard to our EPIDEMIC OF NARCISSISM is that it may be in part the result of
  • Neuro-Diverse people contending with BOTH Greater Sensory Processing and Greater Challenges with Executive Functioning.
  • and that DUAL ASPECT was not what most people, educators or mental health professionals were led to expect.

The mixed bag --- BOTH aspects of this --- is what is desperately needed to be understood in MENTAL HEALTH today.
Preview:  Olmstead Law & Order Thursday

States of Emergency, Public Health & Olmstead

Val's Take
  • Two of the things I really liked about Denver Mayor Mike Johnston's Declaration of Emergency were--
    • He was including PUBLIC HEALTH OFFICIALS, and
    • SOME NUMERIC GOALS
 
  • The role of Municipalities and Counties in Olmstead Planning is interesting --
    • It's the Counties by and large that are bearing the brunt of people with "mental illness" (also BRAIN INJURY, DEVELOPMENTAL DIFFERENCES such as ADHD, AUTISM & DYSLEXIA, & SUBSTANCE PROBLEMS that are often related to one or more of the above) in JAILS,
    • It's Municipalities who are bearing the brunt of HOMELESSNESS.
 
  • If Counties and Municipalities want to start setting their own NUMERIC GOALS to prevent the unnecessary institutionalization or risk of institutionalization from Homelessness -- that could be a very good thing.
 
  • I think those Counties and Municipalities may come knocking on the doors of State Legislatures and Congress.
 
  • At some point --- we're going to start recognizing that our UNDERSTANDINGS and TREATMENTS for some of these underlying issues while not nothing --- are NOT AS GOOD AS THEY NEED TO BE.
 
  • COMING TO TERMS WITH LESS THAN PERFECT TREATMENTS -- Has Ethical, Moral & I would say Legal Ramifications.
    • Just telling SOMEONE TO "TRY HARDER" or we're going to "HELP YOU GET BACK ON YOUR FEET" may actually work in some cases ---
      • BUT for many people with DYSREGULATIONS OF MULTIPLE SYSTEMS OF THE BODY --- a MUCH MORE SOPHISTICATED APPROACH and AWARE Approach is needed.


National Take


Why can't we stop homelessness?

4 reasons why there's no end in sight
Some 19% of those surveyed in the UCSF study became homeless after leaving institutions such as prison, and finding employment and housing with a criminal record is difficult.

Advocates say there's also need for more addiction and mental health treatment, though it's most effective once someone is safely housed.
But again, the overriding problem, they say, is the dire lack of places low-income people can afford to live.


"There's really no way to solve homelessness without seriously addressing this," says Kushel, the UCSF researcher. "Otherwise, we're going to be compelled to continue to spend huge amounts of money managing an increasingly out of control crisis."

Val's Take
  • For a lot of people who are incarcerated and/or chronically homeless ---
    • Housing is very unlikely to be sufficient on its own.
    • On the other hand, any kind of "treatment" is unlikely to succeed without "HOUSING."
 
  • The NPR story itself is evidence that there's wide-spread understanding that there are a lot of people with mental health and addiction problems who are homeless and incarcerated.
 
  • There are more and more people in this country who know that NEURO-DEVELOPMENTAL DISORDERS such as ADHD, AUTISM and/or DYSLEXIA abound in homelessness and incarceration--
    • Those NEURO-DEVELOMENTAL DISORDERS also abound in other areas of the society.
      • Entrepreneurship
      • Academia (what better place to run wild with your "SPECIAL INTEREST")
      • the ARTS and HUMANITIES
      • etc.

EMPLOYMENT has to be part of this discussion as well --- and EMPLOYMENT with an UNDERSTANDING of the DIVERSE GIFTS and CHALLENGES of HYPER-CONNECTED BRAINS.
PREVIEW:  Translational Love, Relationships & Neuro-Diversity

Intensity, Loss & Growth

Val's Take

With a rift in any kind of relationship or a romantic break-up and especially death --- there's a lot of INTEGRATING that into our lives going forward.

When Taylor Swift is writing about a break-up that happened 10 years ago -- I think for the Neuro-Diverse among us ---
  • Yeah so . . .

I've had dates that didn't go anywhere that I still think about and certainly relationships.

With regard to death -- I remember my father saying one of the purposes of showing the body at the funeral was so the surviving family and friends could SEE that the person was no longer the person they knew during life --
  • the person's body/mind was "dead"

The death of my father 16 years ago was scary and traumatic and the OVERWHELMING FEAR was that he would be GONE from my LIFE ---
  • He was "physically gone" and his full being in the world was gone
  • My NEURAL CONNECTIONS were STRONGER THAN EVER.

With the death of my husband Rick --- I'm dead to him --- he's not dead to me.

In trying to move forward I think one's kind of looking for an ESCAPE from:
  • Charles Dickens' "Great Expectations" and Miss Havisham and
  • Emily Bronte's "Wuthering Heights" and Heathcliff, and
  • Charlotte Bronte's "Jane Eyre"

Those 19th Century Novels are dated but they tried to tackle some tough topics for the day.
  • Charlotte Bronte's dealing of "congenital madness" in Jane Eyre is pretty scary by modern standards
    • I think some of what we are doing today is pretty SCARY . . .
      • But we have to lay the FOUNDATION to do something different.

One of the many reasons Rick was so precious to me was that he stayed with me ---
  • I'm not sure I would have stayed with him --- if the shoe had been on the other foot.
  • Now I would -- BUT at the time I was terrified of myself. IGNORANCE really is the ENEMY.
    • Rick was not terrified of me and I'll never forget him saying --- "I love you even more -- you're not so perfect."
      • I didn't think I was perfect and I don't think too many other people did either --- but it meant so much to me that Rick thought that -- sometimes.
 
  • When really struggling with enormous pain, neuropathy and brain lesions, Rick may have forgot I was so perfect (and there may have been other times as well)---
    • But it was not hard for me to remember that he was perfect for me (most of the time).

The man I'm dating now is fond of saying, "We have luggage, not baggage." 
I think this is another version of INTENSITY -- the RESERVED Mr. Bernstein --- there's a lot going on underneath the surface -- that you wouldn't have necessarily guessed seeing him early on.

His guess at the meaning of "Rosebud" is ultimately wrong --- but it tells us a lot about Mr. Bernstein.
PREVIEW:  Law & Order Thursday

Val's Take/Conjecture

Colorado has something most states don't have --- 

The Laura Hershey Memorial Disability Benefits Support Program was created in 2011 by the Colorado State Legislature to "provide education, direct assistance and advocacy for people with disabilities eligible for Social Security Disability Insurance, Supplemental Security Income and Long-Term Medicaid ".

Laura Hershey

en.wikipedia.org/wiki/Laura_Hershey
I did not know Laura Hershey personally --- I did admire her from a far --- I followed some of her writings  -- she was an excellent writer and a very impressive person.

I probably will never be able to gin up the animosity towards Jerry Lewis that she and some other members of the physical disability community have had ---
  • and my perspective was expanded nonetheless.

On the other hand, I think my animosity towards the former Hickenlooper Administration might be hard for others to understand as well.
I've tried to let a lot of that ANIMOSITY go --- not wholly successfully -- but I am still very focused on "OLMSTEAD COMPLIANCE."

Hickenlooper was and is a great politician and one of the things he said -- paraphrasing --- "With public support you can do anything, without it you can't do anything."
I think when we talk about "SUPPORTIVE HOUSING" --- this looks a whole lot like an "UNFUNDED MANDATE" or ---

at least the "HOUSING" part with no adequate source of funding even though there are various HUD monies and other funding sources.

The "Services" should theoretically be covered by MEDICAID --- but in 2015 CMS rejected "HOUSING as HEALTHCARE" --

but CMS noted that STATES still had an obligation under OLMSTEAD to provide it to avoid the unnecessary institutionalization or risk of institutionalization of people with disabilities.

Additionally, many members of the public want  people with "COGNITIVE DISABILITIES"  --- working as a kind of "quid pro quo" for the SUPPORTIVE HOUSING.

Many people with "COGNITIVE DISABILITIES" do want to "work" and/or "volunteer."
Val's Take:  To me, this video from Canada is a WORK OF ART -- a MASTERPIECE --- and there are so many gems that can be mined from it.

I've posted it many times.  For this post, I'm focusing on the words of the psychiatrist who observes that --- most of the people involved with HOUSING FIRST + Assertive Community Treatment are working part time or volunteer work ---

Almost everyone wants to do something productive --- even if --- full time work is not possible.

Additionally, the young woman who is running the "Urban Flower Project" --- admonishes that every business should have a "Hiring Policy" to include these folks.
Further, the psychiatrist --- references "COMPLEX NEEDS."

That covers a lot --- but two of the things I think it covers that are more and more being recognized are:
  • Executive Functioning Challenges, and
  • Idiosyncratic Energy Supplies
There is a need for more PUBLIC EDUCATION regarding "ACCOMMODATIONS" and Work Arounds for Executive Functioning Challenges and various levels of "Fatigue."
"TRY HARDER" which is not all bad --- but for many people with "Cognitive DIFFERENCES/Disabilities" --- it is ACTUALLY MAKING THEM WORSE --- SOMETIMES MUCH WORSE.
  • it's often a combination of the Society and the person themselves NOT UNDERSTANDING that they are pushing things to a BURNOUT or BREAKDOWN.
To make things more confusing for EVERYONE --- the "EXECUTIVE FUNCTIONING CHALLENGES" can be and often are ACCOMPANIED WITH SOME "SPECIAL ABILITIES."
"SPECIAL ABILITIES" that the person needs to "EXERCISE" to maintain MENTAL, EMOTIONAL & PHYSICAL WELL BEING.
Looking for CREATIVE and INNOVATIVE funding strategies for the "Housing PIECE" of Supportive Housing as well as practical technical assistance on ACCOMMODATING:
  • "Executive Functioning Challenges"
  • Idiosyncratic Energy issues as well as
  • "Special Abilities"

in Education, Employment and beyond for purposes of INTEGRATION and INCLUSION.
Preview:  Translational Medicine Friday
The complicated research behind pedophilia

By Alia E. Dastagir
January 2022
Excerpts:
"I think as a field, we've accepted the idea that this is not something that people choose," Seto said.

Seto said pedophilia is something people are born with or at least have a predisposition to. Evidence shows men are more likely to have pedophilia than women.

This aligns with research showing men are more likely to have other paraphilias, including exhibitionism, voyeurism and sadism. Men are also more likely than women to commit criminal acts.

Research also offers insights into risk factors. Seto said men with pedophilia have a much higher incidence of early childhood head injury.

One study on diagnosed pedophiles showed they are more likely to report their mothers had received psychiatric treatment, which suggests the disorder may be influenced by genetic factors.


Pedophiles and the choice to abuse

Salter said when she conducts trainings, she often asked the audience, "How many of you have ever had an inappropriate sexual thought?"
If no one raises their hand, she tells them they're in denial. 


"Of course, people have had inappropriate sexual thoughts. You may be attracted to your wife's sister. You may be attracted to a 16-year-old postpubescent babysitter. It doesn't mean you act on it," she said.

"Pedophiles may not have control over the fact that they are attracted to kids, but they are responsible for whether they do or don't act on it."

Salter said more research is needed to understand why some pedophiles do not act on their attractions, but her clinical observations suggest at least some pedophiles with bad brakes are raised in homes where they were mistreated or neglected. There is also a genetic component, as some pedophiles show psychopathic traits. 
"Where do you want the person? Therapy is where he should be going, and all we've done is make it very, very difficult for a pedophile to get that," Cantor said. "Which to me is insane. It makes the problem worse."
Salter said while pedophiles do not choose their attractions, she does not believe those who offend are being punished unfairly. Treatment should be encouraged, but without minimizing the impact abuse has on victims' lives. 
"It's a choice to act on child molestation," she said. "We don’t need to say, 'Offending isn’t so bad. It really isn’t your fault. ... You really couldn’t control it. You are a victim of a punitive society.' We need to say, 'Offending is devastating. It damages the lives of victims. It has damaged your life. You can learn to control yourself. You have the capacity to do better.'"

Val's Take:  The confused reasoning immediately above is what is being presented to the Criminal Justice System in some cases and the Public.

Is this as bad as Q-Anon --- well,  it's got a professional gloss but the reasoning isn't much better.

I can absolutely understand why people are having a hard time with the ramifications of this --- BUT it doesn't have to be a choice between SAFETY and HUMANE TREATMENT ---
  • and the more we actually understand the BIOMARKERS and SPECTRUMS of this --- the better.

PREVIEW:  Translational Medicine Friday

Looking for  a "Deeper" Understanding of Our "Personality Disorder" Categories


Val's Take/Conjecture

The role of the "Personality Disorder" is very scary in this society.

"Anti-Social Personality Disorder" is pretty much the diagnosis of choice in the Criminal Justice System and at least one state --- my home state of Oklahoma --- has passed a law saying "Anti-Social Personality Disorder" is NOT grounds for the INSANITY DEFENSE.

Well it is not grounds for the INSANITY DEFENSE in most states --- but our limited understandings are VERY SCARY.

And in Oklahoma -- you've still got the Death Penalty.

BUT in other States including Colorado --- we have ridiculously long sentences --- TIME TO DO --- because WE DON'T KNOW WHAT TO DO WITH THE PERSON---
  • AND the HOUSING, SERVICES and PLACEMENTS are NOT THERE in the Quantity and Quality NEEDED.

Some COUNTRIES (Australia) are considering CERTIFICATION for "ANTI-SOCIAL PERSONALITY DISORDER" --- that could be BETTER than what we're doing ---

BUT it is NOT GOING TO BE BETTER --- if we don't address the COMPLEXITY and UNCONSCIOUS BIAS of not only the people in the Criminal Justice System --- but throughout the Society ---
  • that is NO EASY TRICK.

Academics in the US and around the world are now conceptualizing "Anti-Social Personality Disorder' as a DEVELOPMENTAL DISORDER related to ADHD.

Neuro-Developmental and Psychiatric Disorders are more and more viewed as on a CONTINUUM.

Further, how this plays out in the SOCIETY is VERY SCARY as well --- if you are at the BOTTOM of SOMEBODY's PECEIVED TOTEM POLE --- you are putting up with a lot of "SH-T."

Some perceived "HIERARCHY" often prevents us from calling people on this --- AND OFTEN IT IS NOT SAFE TO DO.

That is one of the many reasons why our move to greater and greater "AUTHENTICITY" is so important.

Further, for some of us -- our SOLUTION to this was --- WE WERE GOING TO BE PERFECT --
  • Well, that turned out not to be a very PRACTICAL SOLUTION
  • and I think that is at least some of the success of Aurora Mental Health's amazing campaign "Unpacking Perfect."

There are a couple of lines I want to throw out:

Urban Dictionary: 
  • shit rolls down hill
    • In military parlance it means anything crappy coming from the top of the chain of command will hit everyone down to the bottom. This includes dumbass decision making, disciplinary actions, or simply a superior taking his frustrations out on subordinates.

From the Mini-Series "Chernobyl"
  • "They (the miners) work in the Dark --- They See Everything."

This all has a very PSYCHO-SOCIAL FEEL to it, but what I want to bring in is a "BIOLOGICAL BASIS of BEHAVIOR" ---
  • that is NOT somehow separate from the "ENVIRONMENT"
    • "Environment" is a Physical Environment, Toxins, Micro and Macro Social Environments, etc.

Now --- I'm going to talk in very GENERAL TERMS which is not a substitute for INDIVIDUAL ASSESSMENT and PRECISION MEDICINE.

The MORE STRESS you are under the MORE THAT RAMPS UP SENSORY PROCESSING ---
  • You are looking for a SOLUTION

The CATCH-22 is for people with "HYPER-CONNECTED BRAINS" --- you are also RAMPING UP THE EMOTIONAL DYSREGULATION.
  • because things are "HITTING ALL AT ONCE."
  • additionally, even if you are taking in an ENORMOUS AMOUNT OF INFORMATION (of one or many types)---
    • You're NOT taking in EVERYTHING
    • And you don't have an UNLIMITED ABILITY to PROCESS what you are taking in.

Further, we're contending with the "LIMITS" of our own Cognitive Processes --
  • Just as AI and ChatGPT, etc. --- threaten to make us IRRELEVANT IN OUR MINDS.

Practices such as "MEDITATION" or "PRAYER" of one type or another can be helpful in trying to limit or manage the "SENSORY PROCESSING" as well as RAMP DOWN the EMOTIONAL DYSREGULATION.

But even Buddhists can get into "US vs. Them Thinking" --- Just ask the Rohingya.

This is a HUMAN PROBLEM that if we are HONEST --- most of us did not escape.
PREVIEW:  Neuro-Diversity Wednesday

Asynchrony, "Narcissism," Executive Functioning Challenges & Anxiety

The Need for Double Empathy 360 and a MORE GROUNDED VIEW of Ourselves and Others

PREVIEW:  Translational Justice Monday

Supportive Housing & Justice

This could be seen as a continuation of the Olmstead Law & Order Thursday post below.

Some people with Cognitve Differences/Disabilities do need assistance with CLASSIC ACTIVITIES OF DAILY LIVING.

MOST DON'T.

On the other hand, many need SUPPORT or INDIVIDUALLY TAILORING of their ENVIRONMENTS to deal with EXECUTIVE FUNCTIONING DIFFERENCES/DEFICITS.

Now if you can AFFORD THAT --- GREAT!

But the ASSUMPTIONS within the SOCIETY don't always make it easy.

For people who met the the level of "LONG TERM CARE" --- private insurance and/or Medicaid should be picking up the EXECUTIVE FUNCTIONING SUPPORT.

Now if you try and define out people with COGNITIVE DISABILITIES as Colorado has done --- by limiting the CMHS (Community Mental Health Supports) Waiver to people who need assistance with ACTIVITIES OF DAILY LIVING ----

THAT'S A BIG PROBLEM

The Target Population is NOT NOBODY -- BUT --- it's not most people needing LONG TERM CARE because of a need for SUPERVISION as a result of
  • emotional dysregulation
  • chronic disorganization
  • poor planning skills
  • poor time management,
  • etc.

PREVIEW:  Olmstead Law & Order Thursday

Congratulations to Disability Law Colorado and the Other Winners of NDRN's* Advocacy Awards

GOING FORWARD ON OLMSTEAD . . .

*NDRN -- National Disability Rights Network

NDRN AWARDS

"Four members of the National Disability Rights Network (NDRN) received the NDRN Advocacy Award for outstanding work protecting and advocating for the rights of people with disabilities.

  • Disability Rights Oregon was honored for its efforts to address shortened school days for students with disabilities.
  • Disability Law Colorado was recognized for its advocacy on behalf of incarcerated youth eligible for IDEA services.
  • Disability Rights Connecticut received the award for its work protecting Social Security beneficiaries with representative payees from financial exploitation and fraud.
  • Minnesota Disability Law Center was honored for its legal advocacy and litigation to enforce community integration rights under the landmark Olmstead Supreme Court case.

"The NDRN Advocacy Award is given each year to P&As who have demonstrated outstanding work, allied organizations who have partnered with P&As, as well as to P&A clients who have successfully advocated for improvements in services that not only benefitted them but the broader community of people with disabilities. "


To me,
  • Education,
  • Apprenticeship, Employment, Entrepreneurship
  • and Housing

are the 3 BIG ISSUES for Neuro-Diverse People with an IQ OVER 70 and Low Income  that need to be addressed to prevent the unnecessary institutionalization of Neuro-Diverse People who are often "FLYING UNDER THE RADAR."

This also has the potential to benefit the Society at Large in a big way --- because Sensory, Attention, Executive Functioning and Stress Issues are not rare.

These are issues that are not unrelated to other Healthcare issues such as Cancer, Heart Disease, Stroke and Dementia.


Happy Father's Day
Val's Take/Conjecture

With Neuro-Developmental Differences/Disorders and Psychiatric Disorders --- we're often talking about a combination of GENES from BOTH MOTHER AND FATHER involving the IMMUNE SYSTEM among other things as well as MATERNAL IMMUNE ACTIVATION.
Detection of REST expression in the testis using epitope-tag knock-in mice generated by genome editing (2022)

Abstract
Background: Repressor element 1-silencing transcription factor (REST) is a master regulator that is highly expressed in multipotent stem cells to repress gene networks involving a wide range of biological processes.

A recent study has suggested that REST might be involved in a misregulation of its target genes in the embryonic brain of offspring derived from aged fathers.

However, detailed analyses of the REST function in spermatogenesis are lacking due to difficulty in the detection of REST protein in specific cell types.

[Val's Take:  We may be talking BIOLOGICAL AGE, NOT NECESSARILY CHRONOLOGICAL AGE].

Biomarkers in fathers' sperm linked to offspring autism (2021)

Source:
Washington State University

Summary:
Epigenetic biomarkers in human sperm have been identified that can indicate a propensity to father children with autism spectrum disorder.

In the study, researchers identified a set of genomic features, called DNA methylation regions, in sperm samples from men who were known to have autistic children.

Then in a set of blind tests, they were able to use the presence of these features to determine whether other men had fathered autistic children with 90 percent accuracy.
The inherited methylome landscape is directly altered with paternal aging and associated with offspring neurodevelopmental disorders (2020)
Association of genes within the major histocompatibility complex with attention deficit hyperactivity disorder (1997)

Abstract

The objective was to determine whether a relationship exists among the complement C4B gene, a DR region gene and attention deficit hyperactivity disorder (ADHD).

Thirty-one subjects with ADHD, their mothers, all but 5 of their fathers, and 90 normal subjects living in northern Utah were studied. DR and C4B typing were performed by serologic HLA typing techniques and the DNA methods PCR-RFLP.

The alleles of 2 genes, the null allele of the C4B gene and the beta 1 allele of the DR gene, encode for products involved in immune function and regulation.

Each of these alleles was found to be significantly associated with ADHD.

Moreover, approximately 55% of the ADHD subjects carried both of these alleles on 1 of their chromosomes, compared to only 8% of normal controls.

Genes related to the immune system may be associated with development of the symptoms of ADHD.


See Also
PREVIEW:  Neuro-Diversity Wednesday

Rashoman & Research

The UK and Japan are experimenting with Collaborative Research directed by BOTH Professionals and People with Psychiatric Issues
Val's Take/Conjecture
  • I don't think the "TRUTH" is unknowable
  • On the other hand, it is often NOT KNOWN --- or sometimes worse -- WE THINK WE KNOW BUT WE DON'T.
Daniel Boorstin once advised me that I should be a PHILOSOPHER NOT A LAWYER.  He was probably right.

There are probably few people in which being a PHILOSOPHER is more pragmatic than being a LAWYER --- but I'm probably one of them.

On the other hand,  I don't think I could be the PHILOSOPHER I am today without having been a "LAWYER."
PREVIEW:  Olmstead Law & Order Thursday

Societal Time Management, the "Totality of the Circumstances"

 and Avoiding Institutionalization


Val's Take/Conjecture

  • The HUMANITIES are largely dead in HIGHER EDUCATION ---
    • BUT they have been RESURRECTED in HEALTH CARE.
 
  • The "HUMANITIES and the ARTS" are also a great place to find that "SOCIAL INTERACTION" and FRIENDSHIPS.

"YEAH, YEAH --- But you should see the list of MANDATORY THINGS I'm supposed to do."

AND if I'm Neuro-Diverse and taking in
  • MORE SENSORY INFORMATION ---
  • It's taking me MORE TIME TO PROCESS
  • I've got a "HYPER-CONNECTED BRAIN," and
  • A WICKED INTEGRATED STRESS RESPONSE

you could end up with a Society that looks like the one we have today.

It's very common to see in ADDITUDE Magazine articles on the "ADHD TAX."
Further, a lot of "treatment" for Neuro-Diverse People is not Neuro-Diverse Friendly and in the private sector is often "OUT OF NETWORK."


Below is the Neurodivergent Rebel --- and she's talking about among other things Migraines that she suffered through because no one believed her complaints (migraines are also often associated with mental health concerns).

Beyond migraines and other sensory issues, common issues for Neuro-Diverse people involve various Executive Functioning Challenges --- and it can be very confusing to everyone (including the person themselves).
The problem of "LATE DIAGNOSIS" in Neuro-Diversity is HUGE and it's one of the reasons we have so many crises.

ACCESS TO TREATMENT is an ISSUE --- BUT the need for BETTER UNDERSTANDINGS and BETTER TREATMENTS are also ISSUES.

The American Psychiatric Association Foundation has kinda recognized this --- but the full scale of the problem is not recognized or being addressed as needed.

That is leading to the unnecessary institutionalization and homelessness of NEURO-DIVERSE PEOPLE.

The more INDIVIDUALS, PROFESSIONALS and COMMUNITY MEMBERS understand these SIGNIFICANT DEVELOPMENTAL ISSUES for some people with an IQ OVER 70 --- the BETTER.
PREVIEW Neuro-Diversity Wednesday

Neuro-Diversity in Jail, Prison & Homeless Populations

Val's Take
  • Neuro-Diversity is often presenting such a MIXED, REACTIVE BAG
  • The seemingly EASY OPTION is to provide MEDICATION, TRAINING or THERAPY for the person to become MORE NEURO-TYPICAL.
 
  • I think some of that may be APPROPRIATE and DESIRED BY THE PERSON --- but it is often NOT GOING TO BE SUFFICIENT.
 
  • I think the source of the conflict is often a lack of both SELF-KNOWLEDGE and SOCIETAL KNOWLEDGE.
    • Strengths and Limitations
      • that are not falling within NEURO-TYPICAL RANGES.
 
  • I'm not against MORAL EDUCATION --- but I don't think a lack of MORALITY is what is going on in most cases ---
    • Elevated STRESS RESPONSES
    • EMOTIONS NORMAL in every way BUT INTENSITY
    • Idiosyncratic SENSORY and INFORMATION PROCESSING,
    • Executive Functioning Challenges, and
    • A Society that is just now cluing in that NEURO-DEVELOPMENTAL DISORDERS and PSYCHIATRIC DISORDERS are on a CONTINUUM ---
      • Has led to A LOT OF CRISES --- and nobody wants that.

Neurodivergence in Criminal Justice Network (England & Wales)

ADHD in the Justice System: underdiagnosed and underserved (Multi-Health Systems --- MHS)

It’s Time to Break the Link between Autism and Homelessness
(The Century Foundation)

PREVIEW:  Translational Medicine Friday

A Continuum of Neuro-Developmental & Neuro-Psychiatric Disorders

Val's Take/Conjecture

This could go a lot of ways, BUT ---
  • We do have a number of pieces already in place and to build upon to use this knowledge constructively.

Further, if we thought Cell Phone Cameras could be damning --- some of the EMERGING BIO-MARKERS may be even more challenging.

This is calling for:
  • a much longer view than we often have,
  • a greater commitment to SAFETY,
  • a greater commitment to HUMANE TREATMENT, and
  • a PRO-LIFE commitment that looks different than what it looks like today.
PREVIEW:  Neuro-Diversity Wednesday

The tRNA regulome in neurodevelopmental and neuropsychiatric disease (2022)


1Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
3Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
PREVIEW:  Olmstead Law & Order Thursday

Addressing Educational & Employment Needs of People with ADHD, Autism & Dyslexia as----

An Olmstead Strategy to Reduce the Level of Institutionalization of People with Developmental Differences



Val's Take/Conjecture

  • There is a high CO-MORBIDITY between Neuro-Developmental Disorders such as ADHD, Autism and Dyslexia and various Psychiatric Disorders
  • In fact, Neuro-Developmental and Psychiatric Disorders are coming to be viewed as a CONTINUUM.
 
  • People with Neuro-Developmental Disorders are often coming with "HYPER-CONNECTED BRAINS" ---
    • that can result in amazing STRENGTHS, and
    • WICKED INTERGRATED STRESS RESPONSES (ISR).
 
  • There is a lot of STRESS for many neuro-diverse people in not having ACCURATE DIAGNOSES, ACCOMMODATIONS or WORK-AROUNDS beginning as early as possible.
  • Individuals with ADHD, Autism and/or Dyslexia need to have a fairly good idea by the time they leave High School what ACCOMMODATIONS and WORK-AROUNDS they will need in life.
  • Employment and Entrepreneurial Support can and should benefit Neuro-Typical Citizens as well by providing PUBLIC EDUCATION and SUPPORT for viable employment and business collaborations.

Importantly, many Neuro-Diverse People are not fitting neatly into current DSM Categories ---
  • which is leading to LATE DIAGNOSIS in ADULTHOOD for some people.

Most Researchers today do not view these NEURO-DEVELOPMENTAL and PSYCHIATRIC DIAGNOSTIC CATEGORIES as FIRM or FIXED ---- but much more BLURRED.

This means ACCOMMODATIONS and WORK-AROUNDS will need to be INDIVIDUALLY TAILORED for this REALITY. 
PREVIEW:  Neuro-Diversity Wednesday

The Trials, Tribulations, Individual Skirmishes and Pitched Battles of ---

Neuro-Diverse Abstract and Concrete Thinkers


Another way to think about Abstract Thinking is it tends to be BIG PICTURE THINKERS.
  • An ability at Abstract Thinking or BIG PICTURE THINKING is sometimes associated with DYSLEXIA.

And all of this is very INDIVIDUAL.

I am a BIG TIME ABSTRACT THINKER --- I wouldn't consider myself as someone with Dyslexia ---
  • In fact, learning to read phoenically was hard for me ---
    • I might be much more likely to say --- let's just use the TRADITIONAL WAY.
      • But my Dad had trouble as a child with spelling and may have had some dyslexia.
      • And my daughter has dyslexia
      • Very Well Mind -- "Understanding ADHD & Dyslexia":  In the past, ADHD and dyslexia were viewed as being independent of each other.
        • However, research has shown that executive function impairments related to ADHD are also associated with dyslexia. 





BUT I am a SLOW READER and a SLOW PROCESSOR.
  • I've studied a handful of Indo-European Languages outside of English --- Russian, Latin, French and German
    • I can pick up the grammar fairly quickly but speaking FLUENTLY in any language outside of English ---- Is pretty difficult for me.
    • In elementary school, I did have speech therapy.

Concrete Thinkers might have trouble with Abstract Concepts and take things always "LITERALLY."
Kings College London
Thinking Twice About ADHD and Autism Spectrum Disorder

So the point regarding the video above from Kings College London is there is A LOT OF OVERLAP BETWEEN THE SEEMING OPPOSITES of ADHD and AUTISM.

Further, both ADHD and Autism talk about BURNOUTS and MELTDOWNS and some researchers at least are talking about a CONTINUUM of NEURO-DEVELOPMENTAL DISORDERS and PSYCHIATRIC DISORDERS.

THE DISASTER OF THE DSM --- Late Diagnosis, Too Late Diagnosis, and Many, Many Crises

Even for smart people, I think it takes a minute to appreciate the ramifications of large numbers of the population with:
  • Emotions that are normal in every way except intensity;
  • IDIOSYNCRATIC ways of processing information; and
  • A DIAGNOSTIC MANUAL that is not based on the UNDERLYING BIOLOGY but fairly SUBJECTIVE SYMPTOM CLUSTERS
    • that are often not presenting distinctly in actual people ---
    • but much more blurred.
Translational Justice Monday

Seeing the AFFECTIVE in the PHYSICAL and the PHYSICAL in the AFFECTIVE


Robin Niceta Among Many, Many Others

Family of Robin Niceta releases MRI images, medical records indicating cancerous brain tumor

Val's Take/Conjecture
  • My husband died a little over a year ago from cancer and he had numerous brain lesions
    • and IT WAS VERY DIFFICULT.
 
  • Nearer the end --- he knew his behavior was off --- but there wasn't a lot he could do about it --- AND
    • he could still communicate his wants and desires and he didn't present as CLASSICALLY INCOMPETENT.
    • it made things very difficult -- BUT we did the best we could.
 
  • I've thought a lot about this recently with regard to Paulina Porizkova and her experience with the death of her husband Ric Ocasek with a history of cancer among other things.
    • IT WAS NOT GOOD.
    • and she took it very personally and very much to heart.
      • It's hard not to take it personally quite frankly BUT that just gets you so far and can be a BIG BARRIER to more effectively addressing the issue.
 
  • Beyond CANCER --- BRAIN INJURY is more and more recognized in the Criminal Justice System.
    • Ironically, even some of the PROFESSIONALS who are IDENTIFYING THIS are not necessarily prepared to address the UNDERLYING LOGICAL CONCLUSIONS from this ---
      • and would still say --- "Oh, but the person should still be held criminally responsible."
      • Really?
 
  • In 2023, I think we're pretty much prepared to recognize:
    • FLORID PSYCHOSIS
    • DEMENTIA
    • Maybe off the wall diagnoses like Huntington's Chorea
 
  • Robert Sapolsky at Stanford really cuts through this and recognizes a kind of UNDERLYING ALGEBRA to these issues --
    • he doesn't get caught up in the specific UNDERLYING DIAGNOSIS ---
    • BUT understands MORE FUNDAMENTALLY--- that there are BIOLOGICAL EXPLANATIONS for HUMAN BEHAVIOR.
What we don't want to do is recognize a very LIMITED CLASS or CLASSES of BIOLOGY as EXCULPATORY ---
  • and INCENTIVIZE pretending to be "PSYCHOTIC" for example
    • As someone who actually did have a dangerous psychotic episode
      • I would not wish that on my worst enemy and
      • in the words of Carrie Fisher -- "Better Me, Than You."


Further, to me --- We don't want to WASTE a lot of TIME and RESOURCES trying to FIGURE OUT WHO TO PUNISH.

We need to put most of our EFFORTS into first providing for SAFETY --- and THEN
  • getting down to the specifics of the UNDERLYING BIOLOGY ---
  • and addressing that as best we can.
  • and providing that research and translational research and medicine that could improve our approaches and outcomes.

There can be ENORMOUS COMMONALITY OF INTEREST among INDIVIDUALS, VICTIMS and the COMMUNITY in taking such an approach.
  • especially if we're including people in a RESTORATIVE JUSTICE APPROACH.

BUT "RESTORATIVE JUSTICE" does need to incorporate more sophisticated "PUBLIC HEALTH APPROACHES" ---
  • or in many cases it WILL NOT BE EFFECTIVE.
Picture
Table 1 -- From Dialogues in Clinical Neuroscience & the Semantic Scholar
Affective Immunology

Affective immunology: where emotions and the immune response converge
Dialogues in Clinical Neuroscience (2017) <<Link

"Recent compelling evidence has shown that the emotional and immunological systems share more than a similarity of functions.

"This review article will discuss the crosstalk between these two systems and the need for a new scientific area of research called affective immunology.

"Research in this field will allow a better understanding and appreciation of the immunological basis of mental disorders and the ​emotional side of immune diseases."


Bioactive lipids as modulators of immunity, inflammation and emotions.
Current Opinion in Pharmacology (2016) <<Link
Translational Love & Relationships Saturday

The MANY ROLES of Neuro-Diverse Oppressor & Oppressed

"RIVER" --- The Complicated "RIVER" of TRAUMA

It is rarely as NEAT and TIDY as "KARMA" if we view it on an INDIVIDUAL LEVEL.

If we view it as more challenges of the HUMAN CONDITION and SOCIETIES and Complicated CAUSE & EFFECT RELATIONSHIPS --- maybe.

One of the things the ART of DRAMA does particularly well is bring together the PERSONAL, WORK and the SOCIETAL to get to some NEW INSIGHTS.

Neuro-Diverse people who are experiencing EMOTIONS THAT ARE NORMAL IN EVERY WAY BUT "INTENSITY" are quite vulnerable to PTSD and other psychiatric issues.

Those "NEURO-DIVERSE" people are NOT just in one segment of the society.
One of the BIG THINGS that has made it DIFFICULT for INDIVIDUALS, FAMILIES, PROFESSIONALS and SOCIETIES ---
  • PARTIAL UNDERSTANDINGS
  • IGNORANCE
  • NEW UNDERSTANDINGS that RAISE REASONABLE DOUBT about how we're handling things ---
  • BUT NOT THE DEFINITIVE --- "THIS IS THE ANSWER."

I think for Neuro-Diverse Individuals, Families, Professionals and Societies in 2023 ---
  • There is plenty of room to make TRANSFORMATIONAL CHANGES based on the KNOWLEDGE we've gotten in the last 10 Years.

This is NOT UN-RELATED to OLMSTEAD PLANNING ---
  • This does not WORK as a ONE & DONE PROPOSITION.
  • Whether our UNDERSTANDINGS OF:
    • OURSELVES
    • OUR PARTNERS or SPOUSES
    • KIDS
    • FAMILY MEMBERS
    • Co-Workers
    • OR THE NEEDS OF THE COMMUNITY

For many Neuro-Diverse people --- there is a NEED for PUBLIC EDUCATION.

THERE'S REAL TRAUMA ASSOCIATED WITH A "LATE DIAGNOSIS."
  • We need to better integrate the knowledge we have,
  • Build on it ---
  • and Continue to do the HARD WORK of INTEGRATING KNOWLEDGE FROM MULTIPLE SOURCES.
Translational Medicine Friday

The CROSS-DISABILITY MOVEMENT ---
AHEAD OF IT'S TIME

No Problem We'll Push for CHANGE

Val's Take
  • My rap has been --- Hey, I don't have a problem with a "MEDICAL MODEL" --- I just want a competent "MEDICAL MODEL."
 
  • The DISABILITY COMMUNITY in some ACTIVIST QUARTERS rejected the "MEDICAL MODEL" for a number of reasons.  Two Big Reasons ---
    • The "MEDICAL MODEL" was often focused on a CURE --- that wasn't necessarily going to be here in your LIFETIME, and
    • People in the ACTIVIST DISABILITY COMMUNITY were picking up a lot quicker than the REST OF THE SOCIETY or even the MEDICAL COMMUNITY that ---
      • There were a lot of COMMONALITIES among these DISABILITIES --- and
      • FUNCTIONAL ASSESSMENTS were a BIG KEY to getting APPROPRIATE SERVICES.
Below:  Where did I find this artist rendering of Latonya --- On a physical disability site ---- No, a twitter feed for people of color with autism.
Latonya had an incredible appreciation for the challenges of not only PHYSICAL DISABILITIES but also COGNITIVE DIFFERENCES.

She served on the PAIMI Board at The Legal Center for People with Disabilities and Older People, now Disability Law Colorado.

PAIMI stands for Protection and Advocacy for People with Mental Illness.

As we are starting to INTEGRATE PHYSICAL and MENTAL HEALTH --- I feel that the DISABILITY COMMUNITY is leading again in its appreciation of INTER-DEPENDENCE  --- which can help get us out of US vs. THEM THINKING and to MORE HUMAINE, REALISTIC and PRACTICAL SOLUTIONS.
PREVIEW:  Neuro-Diversity Wednesday

PEOPLE PLEASING vs. DEMAND AVOIDANCE ---

Two Sides of the Same Coin?

And there are many other such coins.

Val's Take/Conjecture
  • Aristotle is famous for some things and infamous for some things.
  • One of the things that he is famous for is the ARISTOTELIAN MEAN ---
    • It's often a kind of Goldylocks idea ---
      • not too hot, not too cold --- just right.
 
  • NEURO-DIVERSE People are often at the EXTREMES
 
  • I think LAW and JUSTICE are often trying to get to some kind of ARISTOTELIAN MEAN in a way.
    • The SCALES OF JUSTICE

WHEN IT COMES TO HEALTH --- It Seems that is always a MOVING TARGET.

  • Another idea is "KNOW THY SELF" --- But that SELF is CHANGING sometimes getting STRONGER and sometimes getting WEAKER.
    • In "some" ways I'm in the best shape of my life having gotten to the worst shape in my life by the time of my husband's death.
      • Further, I'm still short and
      • I still feel relatively stocky.
    • BUT that's complicated and for me expensive.
    • I have some health issues --- I'm trying to avoid a Hysterectomy
      • I'm doing Pilates often 7 days a week and
      • Some physical therapy which insurance hasn't covered -- but I'm hoping will now that UCHealth is specifically recommending it.
 
  • So the point I want to make is that outwardly --- I look better (I am setting this bar way too high --- not perfect) --- inwardly things are physically "breaking down"
    • It's taking BOTH MORE TIME, ENERGY and RESOURCES to keep me HEALTHY.
 
  • When my husband was sickest with cancer --- we re-allocated resources for Home Health and a Ramp --- things kept changing ---
    • It was hard to keep on top of it.
    • It was also hard to SCHEDULE the home health for what we really needed and not end up paying for what we didn't.
      • Because the DEMANDS could be FLUCTUATING
    • I think for the most part Rick was ROUGHLY COMPETENT
      • NOT TOTALLY COMPETENT
 
  • Some of these issues --- I think both NEURO-DIVERSE People and those in their lives (who are also dealing with their own issues) need to ADDITIONALLY UNDERSTAND AS PHYSICAL ENERGY ISSUES.


Dr. Gabor Mate has articulated this idea of "THE BODY SAYS NO" and popularized it with regard to Chronic Illness & Disease.

Paul Micallef takes that idea and applies it to "AUTISM."

Mate brings in TRAUMA, the SOCIETAL STRUCTURES,  AUTHENTICITY, STRESS, etc.

I think Paul really adds to this by saying that "We all have to play within our own limitations."  I think this is also related to ideas we have around "HOMEOSTASIS."

In the case of "NEURO-DIVERSITY,"  I would certainly include IMPROVED KNOWLEDGE and AWARENESS on the part of the PERSON and the SOCIETY.

I don't think Neuro-Developmental Inflammation and Dysregulation is the only driver of our CHRONIC DISEASE, NEURO-DEVELOPMENTAL DISABILITY/PSYCHIATRIC DISORDER EPIDEMIC
  • BUT IT'S RIGHT UP THERE.
Val's Take:  Yeah this can be about romantic relationships --- I think it can also be about our relationships with ourselves and with our understandings of the world and situations we find ourselves in.

WHAT DID I KNOW . . .

There are an INFINITE Number of Levels on which to LOOK AT A PROBLEM.

But there are 3 Levels we often use:
  • the LEVEL we're at,
  • MORE MACRO LEVELS,
  • MORE MICRO LEVELS
I would say that even beyond SOLVING A PROBLEM on a DIFFERENT LEVEL --- WE NEED To INTEGRATE AS MANY LEVELS AS WE CAN.

THAT IS NOT A ONE AND DONE PROCESS.

Further, I think before we have a NEW ANSWER --- we have ANOMALIES and DOUBTS about our CURRENT ANSWER --- a la Philosopher of Science Thomas Kuhn.

To me, that is what is happening in LAW and CRIMINAL BEHAVIOR and challenging behavior throughout the society.

For me, I already have REASONABLE DOUBT about how we're handling CRIMINAL CASES and "BAD BEHAVIOR" in the Society, and I think as a SOCIETY we are certainly EXPERIMENTING with OTHER MODELS.

To me, there are 2 BIG "BOUNDARIES" for any SOLUTION:
  • We have to have SAFETY, and
  • We have to have HUMANE TREATMENT.
----BUT that is not STATIC --- it depends on our knowledge level
  • AND how many different perspectives and levels we are incorporating and integrating into our SOLUTIONS.

As we're integrating PHYSICAL and MENTAL HEALTH and relationships to:
  • SOCIAL ENVIRONMENT,
  • TOXINS,
  • EARLY DEVELOPMENT, and
  • Other Systems of the Body Beyond the Brain, including
    • the Immune System
    • the Microbiome
    • Metabolism, and
    • the Endocrine System
  • As well as finding BIO-MARKERS in the BLOOD  -- the CIRCULATORY SYSTEM
    • for things that were previously considered STRICTLY MENTAL

As we are moving to that PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE ---
  • We're becoming KEENLY AWARE that the ENORMOUS RESEARCH we already have is NOT INTEGRATED into CLINICAL PRACTICE--- and
  • MUCH LESS the FLOOD that is coming this year and likely even more in the coming years.

There feels to be a TEMPORAL SPACE between the SIMPLICITY on the NEAR SIDE OF COMPLEXITY and the SIMPLICITY on the FAR SIDE OF COMPLEXITY (per Oliver Wendell Holmes, Sr.).

We need Interim Procedures for this TIME and SPACE where we are BEYOND SIMPLICITY ON THE NEAR SIDE OF COMLEXITY but not yet to the SIMPLICITY on the FAR SIDE OF COMPLEXITY.


PREVIEW: Neuro-Diversity Wednesday

Bodies of People With Mental Illness Are Biologically Older Than Their Actual Age

Neuroscience News
March 27, 2023

Val's Take/Conjecture
  • I think there are a lot of reasons for why people with mental illness are biologically older than their actual age ---
  • BUT if we're missing MATERNAL IMMUNE ACTIVATION --
    • We're missing the boat in many cases.
 
  • in the 1950s and 1960s --- HEART ATTACKS were the big killers -- they are still big killers but they are not killing people in their 40s and 50s like they were.
 
  • My Dad who was going bald in high school --- had a friend who died in his 40s from a heart attack.
 
  • At that time --- weight, smoking and having a "Type A" personality were identified with HEART ATTACK risk.
 
  • My Dad predicted that I might have a HEART ATTACK by my early 40s if I didn't chill out a little bit.
 
  • Well, I didn't have a HEART ATTACK --- but I did have a A PSYCHOTIC EPISODE.
    • Further --- I may not have had a MAJOR STROKE -- but I may have had a MINI-STROKE at 43 ---
    • That had been preceded by about 6 years of MIGRAINES.
 
  • Further, "PEDIATRIC STROKE" is being linked to AUTISM. --- How many people even know that is a "thing."
 
  • The point I'm trying to make is I think we need to BROADEN OUR FOCUS to see CONNECTIONS between INFLAMMATORY HEALTH ISSUES.
    • I'm not saying we shouldn't DRILL DOWN to more specific understandings.
    • BUT understanding some of these "RELATIONSHIPS" I think can bring more effective treatments and help us identify issues much earlier.
This is the National Institute of Mental Health's video from a decade ago recognizing that ADHD, Autism, Depression, Bipolar Disorder and Schizophrenia --- SHARE COMMON GENES and often involve CALCIUM CHANNEL DISRUPTIONS.

Since that time, Researchers are conceptualizing Neuro-Developmental and Psychiatric Disorders as on a CONTINUUM.

Further, MATERNAL IMMUNE ACTIVATION is now often associated with Neuro-Developmental Disorders and more and more with Psychiatric Disorders.

Further, NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS are often associated with DYSREGULATIONS in METABOLISM, the MICROBIOME, the ENDOCRINE SYSTEM and the IMMUNE SYSTEM.

Many CHRONIC DISEASES --- have PSYCHIATRIC COMPONENTS.

I think NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS do have PHYSICAL COMPONENTS but they can appear MORE SUBTLE, especially when we haven't known what to look for.

People with CLASSIC PHYSICAL, NEURO-DEVELOPMENTAL and MENTAL HEALTH DISORDERS need PHYSICAL, NEURO-DEVELOPMENTAL and MENTAL HEALTH PRACTICE --- INTEGRATED.
Human Aging Is the End-Product of Our Developmental Program

Neuroscience News
March 28, 2023
Picture
University of Birmingham, UK
"Summary: A new study reports aging may not be a result of accumulative damage to the body, but instead is the result of “design” flaws in our DNA that orchestrates the development of single cells into an adult organism."
According to the study’s authors, aging therapies will only be effective if they target the software of the body rather than the hardware.

This new perspective has important implications for our understanding of aging and the development of interventions to promote healthy aging.


Professor João Pedro Magalhães from the University of Birmingham who led the research, said, “Our model is controversial as it challenges the prevailing view of aging as a result of random damage to the body’s hardware.

Instead, we suggest that aging is an information problem that is driven by design flaws in our body’s software.


“As the developmental program runs early in life, it is beneficial, but its runs later in life become detrimental and drive tissue degeneration and aging phenotypes.”

To me, the question is where are these "DESIGN FLAWS" coming from.

I think NEURO-DEVELOPMENTAL INFLAMMATION is playing a big role in our PHYSICAL & MENTAL HEALTH ISSUES and we're just not paying enough attention to DEVELOPMENTAL ISSUES ARISING OUT OF PREGNANCY.

Further, I don't think we should be IGNORING these issues --- BUT it doesn't make sense to PUNISH them either.

The "LIFESTYLE ISSUES" we've been focusing on aren't nothing, BUT I think DEVELOPMENTAL ISSUES OFTEN OUTWEIGH or OFTEN DRIVING PROBLEMATIC LIFESTYLE ISSUES.

Having said that --- where can you realistically have an impact --- maybe it is on those "LIFESTYLE ISSUES" ----
  • But that may require MORE THAN what we are currently advising AND
  • Somehow this all has to fit into a 24-Hour Day.

I think most people are familiar with the phrase being "NICKLED and DIMED"  --- those small amounts of money add up.

There's no shortage of well-meaning people willing to tell you exactly what you need to do and it will only take 5 minutes. 
  • Well, that adds up.

So for some NEURO-DIVERSE PEOPLE we may need to change our LIFESTYLES to more ACCURATELY FIT OUR DEVELOPMENTAL NEEDS.
PREVIEW:  Translational Justice Monday

We do have ACCESS ISSUES in "MENTAL HEALTH."

BUT Until We're Willing to Deal with the IMPLICATIONS OF A CONTINUUM OF NEURO-DEVELOPMENTAL & PSYCHIATRIC DIFFERENCES/DISORDERS ---

We're Going to Continue to WASTE A LOT OF MONEY
Val's Take
  • There's a need to BUILD A BRIDGE to MORE EFFECTIVE MENTAL HEALTH --- NEURO-DEVELOPMENTAL Treatment in the Next 10 Years.
  • Further, the NUMBERS OF PEOPLE NEEDING THIS ARE INCREASING.
 
  • WHY THEY INCREASING? 
    • More People are being born with the Developmental Effects of MATERNAL IMMUNE ACTIVATION.
    • We're recognizing it more.
    • We're starting to recognize DIVERSE EFFECTS and SEX-SPECIFIC EFFECTS that do not easily fit into CURRENT DSM CATEGORIES.
    • The effects of SMOKING during pregnancy can last MORE THAN ONE GENERATION.
    • There are probably other things that are influencing this --- that can last "MORE THAN ONE GENERATION."
 
  • In some cases, Mental Health is serving a HYBRID-QUASI RELIGIOUS ROLE to hold Secular Societies together ---
    • When the SCIENCE has been LAGGING.
 
  • Well, the SCIENCE is starting to CATCH-UP --
    • And there is a fair amount of RESISTANCE in the STRUCTURES that were created and empowered in the INTERIM.
 
  • I don't think it is WRONG to SCREEN for DEPRESSION --- BUT we're needing to UP OUR GAME in SCREENING for ADHD, Autism, Dyslexia and BLURRED ASPECTS of these DIFFENCES/DISORDERS that are not fitting neatly into current categories.
 
  • I do think the FEDS should fund the RESEARCH and SYNTHESIS of a new INTEGRATED DSM that addresses MULTIPLE SYSTEMS of the BODY --- to the BEST OF OUR CURRENT KNOWLEDGE -- and that should be REGULARLY UPDATED (probably more than yearly).
    • We need to get this OUT of the AMERICAN PSYCHIATRIC ASSOCIATION.


Olmstead Law & Order Thursday

Olmstead and School Shootings

Val's Take
  •  I remember when Columbine happened and our kids were babies ---
    • Oh --- I'll never send them to Public Schools.
  • Of course, a lot of stuff can get SWEPT UNDER THE RUG at higher end or private schools ---
    • and there can be more SOCIAL PRESSURE to SHUT UP ABOUT IT.
  • This was also around the time of the Elizabeth Smart Kidnapping --- so if you are parent --- this is a very scary time.
  • Our kids did go to Public Schools.
  • Michael was in the weight room of Arapahoe High School during the shooting there ---
    • Teachers and Coaches locking kids in --- "Get the F---- Down"
  • Laura was locked down at Newton Middle School during the Arapahoe High School Shooting.

I would later write that some middle and upper middle class high schools don't have the SCHOOL TO PRISON PIPELINE ---
  • but BEHAVIOR ISSUES within the school are dealt with ---- with a never ending series of WARNINGS.

BUT to do SOMETHING other than WARNINGS --- you need OPTIONS and you need options that SPAN THE FULL CONTINUUM OF CARE.

THE HIGHER UP ON THAT CONTINUUM OF CARE you need to go --- the MORE EXPENSIVE IT TENDS TO BE.
I think there is a "HARM REDUCTION" Component to the Olmstead decision.

All "Institutions" are not created equal.

Further, Sentencing in Criminal Justice is almost always ARBITRARY & CAPRICIOUS ---
  • when the underlying issue is often NEURO-DEVELOPMENTAL
    • and that cuts both ways --- probably multiple ways.

Excitotoxicity in the Pathogenesis of Autism (2013)
Affiliation
  • Department of Food Science and Nutrition, College of Agriculture and Marine Sciences, Sultan Qaboos University, Muscat, Oman.
Abstract

Autism is a debilitating neurodevelopment disorder characterised by stereotyped interests and behaviours, and abnormalities in verbal and non-verbal communication.

It is a multifactorial disorder resulting from interactions between genetic, environmental and immunological factors. Excitotoxicity and oxidative stress are potential mechanisms, which are likely to serve as a converging point to these risk factors.

Substantial evidence suggests that excitotoxicity, oxidative stress and impaired mitochondrial function are the leading cause of neuronal dysfunction in autistic patients.

Glutamate is the primary excitatory neurotransmitter produced in the CNS, and overactivity of glutamate and its receptors leads to excitotoxicity.

The over excitatory action of glutamate, and the glutamatergic receptors NMDA and AMPA, leads to activation of enzymes that damage cellular structure, membrane permeability and electrochemical gradients.

The role of excitotoxicity and the mechanism behind its action in autistic subjects is delineated in this review.

Excitotoxicity, calcium and mitochondria: a triad in synaptic neurodegeneration (2022)


See also:
  • Excitotoxicity, defined as cell death resulting from the toxic actions of excitatory amino acids, is actually considered as a major factor contributing to the early stage of ischemic cell death in stroke.

www.intechopen.com/chapters/52208
Excitotoxicity and Oxidative Stress in Acute Stroke | IntechOpen

'Majority' of stroke patients might have undiagnosed attention disorders (2013)

The majority of stroke patients may have attention disorders, most of which are not diagnosed, according to a study published in the journal Neurology.

Mini-Strokes Lead to PTSD & Other Psychiatric Disorders

[Val's Note:  This connection between STROKE/MINI-STROKE and Attention Disorders and Psychiatric Disorders/Psychosis --- I think is SIGNIFICANT]

Val's Take/Conjecture
  • I think there are many connections between Neuro-Developmental Issues and Developmental Inflammation and later Health Problems such as STROKE, DIABETES, PSYCHIATRIC DISORDERS, CANCER, etc.
  • And they have tended to sneak up on us.  The more advance notice we all have --- the more we can plan for some of these issues.
  • Especially, for people who are not overweight and do not smoke.
  • BUT even for people who are struggling with weight or smoking ---this is often more complicated than we think.
    • Smoking can be --- a means of CALMING an ADHD mind and a lot of women especially in the 20th Century used smoking to not only calm themselves but also to help control their weight.
  • For people who are overweight in 2023 --- that's very complicated --
    • It's not like Diet and Exercise don't matter ---
    • BUT there's often more going on than that --- and DEVELOPMENTAL INFLAMMATION during pregnancy can dysregulate a number of systems --- including METABOLISM.
    • Some researchers are saying that some modern people have to work HARDER to control their weight than just a few generations ago. 
Why It Was Easier to Be Skinny in the 1980s (2015)

A new study finds that people today who eat and exercise the same amount as people 20 years ago are still fatter.

Translational Justice Monday

Justice & Health Care:

Addressing Underlying Neuro-Developmental Issues
Val's Take/Conjecture
  • One of the things that I really like about LAW & MEDICINE is THEORETICALLY they are taking things on a CASE-BY-CASE BASIS.
  • On the other hand --- there are BIG SYSTEMIC ISSUES certainly in LAW (and Medicine) that don't get addressed very well.
 
  • Mixing my metaphors, POLICY-MAKERS and THE REST OF US are often in the position of LAYING A FOUNDATION and BUILDING BRIDGES
    • Planting those Trees whose Shade we will never sit under.
 
  • Right now in Criminal Justice the STANDARD for HEALTHCARE in Jails in Prisons is pretty low: "DELIBERATE INDIFFERENCE."
 
  • Even with that most jails and prisons STRUGGLE to meet the PHYSICAL & MENTAL HEALTH CARE NEEDS of the Population.
 
  • This is a problem throughtout the SOCIETY ---
    • We do something --- but its WOEFULLY INADEQUATE to the TASK AT HAND.
 
  • INTEGRATION is a DIALOGUE and ultimately its a lot of THIRD ALTERNATIVES  that are actually going to work.
 
  • We do have limited RESOURCES ---
    • I don't necessarily think that a lot more JUDGES and ATTORNEYS to feed a PURE ADVERSARY SYSTEM are a good use of resources.
    • There's a role for the ADVERSARY SYSTEM -- generally where FACTUAL MATTERS are genuinely in DISPUTE.
    • We've moved to HYBRID SYSTEMS --- Problem Solving Courts, etc.
 
  • One of the HUGE CHALLENGES right now is that we know enough to know:
    • We've gotten some of this wrong
    • For example, the Mental Health Profession's Diagnostic and Statistical Manual is NOT scientifically valid ---
      • at least according to the National Institute of Mental Health in 2013
 
  • Our TREATMENTS are often better than NOTHING --- but for many people they are NOT SILVER BULLETS and --
    • there's often an underlying NEURO-DEVELOPMENTAL ISSUE that is not being sufficiently addressed.
 
  • I think NEURO-DEVELOPMENTAL ISSUES & INFLAMMATION are issues not only in Homelessness, Criminal Justice and "MENTAL HEALTH CARE" ---
    • but in HEALTH CARE in general.
    • and may be factors in some of our CHRONIC DISEASE problems fairly across the board.
 
Val's Take:  I think a lot of people are skeptical about the increase in "ADHD" --- but if you look at what drives it ---- It's not that surprising.

Further, a factor like smoking can last more than than one generation.

Below "Smoking During Pregnancy and Risk of ADHD in the Third Generation."

At some point we have to stop "JUDGING" each other and address these complicated HEALTH ISSUES as best we can.

That does mean providing for SAFETY.

Val's Note:  Below is a good example of me making a CONSCIOUS PRIORITY CHANGE --- I had planned to collect my information calling into question the DSM ----
  • And what happened was I noticed my page that is pretty harsh on clinical and forensic clincians was getting a lot of hits.
  • On that page is a TedTalk by a very bright woman with Chronic Fatigue Syndrome (CFS).
    • She is furious with the medical profession --- and I can relate to that.
    • BUT one of the things that she also says is --- "Hey, this isn't psychiatric."
      • Well --- there are physical symptoms of CFS BUT there are also psychiatric symptoms.
      • We do tend to make "DESCARTES ERROR" --- this is one or the other -- PHYSICAL or MENTAL --- and most things are both --- even COVID.
 
  • Further, a lot of people with AUTISM/ADHD --- may not have the "FATIGUE" of CHRONIC FATIGUE SYNDROME ---
    • But we are really subject to BURNOUT AND BREAKDOWN.
 
  • For me personally, there's a kind of "DAY LIGHT SAVINGS TIME" ---- I'm focused on what is "INTERESTING" to me ---
    • That can look either VERY SELFISH or PSYCHO-SOMATIC ---
      • What do you mean you only have ENERGY for the things "YOU'RE INTERESTED IN." ---
      • HOW CONVENIENT!
        • Well, it's actually not very convenient --- it puts a big strain on relationships.

  • BUT I do have real ENERGY CHALLENGES --- and IGNORING THAT --
    • IS NOT SAFE




Effect of Adding l -Carnitine to Risperidone on Behavioral, Cognitive, Social, and Physical Symptoms in Children and Adolescents With Autism (2023)


Conclusions: According to the present study, adding l -carnitine to risperidone improves ASD symptoms.
Potential Role of L-Carnitine in Autism Spectrum Disorder (2021)
Is Autism Related to Chronic Fatigue Syndrome and Fibromyalgia? (2012)

The nutrient L-carnitine appears effective in treating all three.
What I'm going to post Today
  • Problems with the DSM 5
    • including the work of Colorado Researchers and others around the world

Later This Week and Next Week:
  • A Paradigm Shift viewing Neuro-Developmental Differences and Psychiatric Disorders on a CONTINUUM
  • Association between BRAIN INJURY and Neuro-Developmental Disorders
  • Association between Substance Issues and Neuro-Developmental Disorders
 
  • Current estimates of:
    • Neuro-Developmental Differences
    • Psychiatric Disorders
    • Brain Injury, and
    • Substance Issues in
              Criminal Justice

  • New Understandings of "Anti-Social Personality Disorder" as a Neuro-Developmental Issue.
 
  • Certification Proposal for people with Neuro-Developmental Challenges that result in danger to self or others or gravely disabled and an IQ over 70.

  • General Resources on a Public Health Approach to Criminal Justice
 
  • The need for such a PUBLIC HEALTH APPROACH to go beyond traditional Mental Health to INTEGRATED PHYSICAL/MENTAL HEALTH ASSESSMENTS and PLANS OF CARE.
    • Shared Decision Making is important while maintaining safety.
PREVIEW:  Translational Justice Monday
Addressing Executive Functioning as a Justice Issue

Val's Take/Conjecture

"Standard Executive Functioning" when I was growing up was just being "RESPONSIBLE."
  • If you are a big time PEOPLE PLEASER like I was --
    • You can PEOPLE PLEASE yourself right into the PSYCH WARD.

On the other hand, this goes WAY BEYOND "PEOPLE PLEASING" to PROFOUND IGNORANCE and JUST NOT KNOWING on the part of not only myself and people close to me ----
  • BUT Professionals as well.

The problem with NOT KNOWING is YOU DON'T KNOW WHAT YOU DON'T KNOW.

I think a lot of RESEARCHERS are getting us on the RIGHT TRACK --- Understanding the IMPLICATIONS of:
  • MATERNAL IMMUNE ACTIVATION
  • HYPER-CONNECTED BRAINS, and
  • SHARED GENES

To me this is causing a lot of FEAR and TENSION in the SOCIETY --- because our OLD WAYS and NEW WAYS of trying to MANAGE THIS ---
  • are needing to be MODIFIED
  • not based on some ABSTRACT PRINCIPLE of REASONABLENESS
  • BUT based on the REAL STRENGTHS and LIMITATIONS of IDIOSYNCRATIC REAL PEOPLE ---

Understanding NEURO-DIVERSE EXECUTIVE FUNCTIONING ISSUES and ENERGY ISSUES are BIG KEYS.


Val's Take:  I think unless we and the people around us or the people close to us UNDERSTAND our ENERGY CHALLENGES that can be VERY CONFUSING.

Even when I was single and no kids ---- I couldn't really work an 8 hour day.

When our kids were growing up ---- I was only working part-time --BUT that included a lot of TRANSITIONS I needed to make everyday and my husband was working often long hours.

For most people --- it would be such an EASY LIFESTYLE --- but for me it was--- too much.

Neuro-Diverse Women have some unique issues here:
  • Menustration
  • Pregnancy
  • Childbirth, and
  • Menopause
can sometimes be more problematic.  There's sort of a whole group of women who really experience their most significant mental health issues in their 40s or later.

That is an important SEX DIFFERENCE and is DIFFERENT than this idea that this is all coming to light in ADOLESCENCE ---
  • for some people it does ---
  • others it doesn't

Additionally, what is "REASONABLE" really depends on the "TOTALITY OF THE CIRCUMSTANCES"
  • If you were living 125 years ago and making a land run into Oklahoma
    • You were 16 and illiterate and so was your spouse
    • and it was very clear what you were going to do with your life
      • You were going to farm land
      • Then maybe that works until the next generation hits the DUST BOWL.

The transition from an AGRARIAN ECONOMY to our current TECHNOLOGICAL ECONOMY has been very rapid.
  • Even with EPIGENETICS --- and maybe because of EPIGENETICS
  • We seem to have a lot of mismatches between our SOCIETIES and OUR BIOLOGIES
    • I think we have some of the same and our own unique challenges in 2023 --- but challenges of different types have always been there.
    • BUT they are coming into some pretty HIGH RELIEF in MANY ASPECTS in 2023.

If we're looking back 125 years ago --- 18 probably seemed OLD -- not YOUNG to say someone was an ADULT.
  • BUT there are REASONS for that
  • ADULTHOOD was NOT NEAR as COMPLEX as it is in 2023.

One of the things my American History professor was fond of saying:  "CHANGE EQUALS STRESS"  -- that's NOT limited to Americans.
  • I would say in at least some cases that STRESS is going to lead to MATERNAL IMMUNE ACTIVATION,
  • That INFLAMMATION is going to provide a wide variety of individuals to try to deal with this NEW ENVIRONMENT.

We've gone a considerable way in understanding the need for "DIFFERENT STROKES FOR DIFFERENT FOLKS" ---
  • I think that is a lot easier to understand if we have BIO-MARKER CROSS REFERENCES.
    • That hasn't always been possible --- it's now happening and will likely continue.

One of the ironies of the debates of the 20th Century regarding Communism and Capitalism:
  • to each according to his need --- sounds great --
    • BUT do you know what that is?
    • If you do know what that is ---- you probably don't need a REVOLUTION
  • some of those NEEDS are the driving force behind ENTREPRENEURSHIP
    • Entrepreneur ranks are filled with a lot of Neuro-Diverse People that:
      • Often do have some huge strengths
      • BUT that came at a COST.

Toronto academic and psychologist Tayyab Rashid makes the point that: "Nobody has it all, nobody lacks it all." 

Additionally, Clarence Darrow was right when he said: "In one sense, we are all equally good and equally bad --- we all do the best we can under the circumstances."

Those "CIRCUMSTANCES" can be a lot of things:
  • a social environment
  • a chemical environment
  • a microbiome environment
  • an in-utero environment
  • etc.

Part of getting out of our CURRENT TOWER OF BABEL is recognizing that and increasing our sophistication in EMPOWERING DIFFERENT MINDS to work together to live our best lives ---
  • Which most of us would gladly do -- with more understanding. 
  • Stephen Covey: SEEK FIRST TO UNDERSTAND.
    • This is the work of the one relationship but its also the work of GENERATIONS.




I think there are a lot of NEURO-DIVERSE Men (and Women) who are "JUSTICE-INVOLVED" on both sides of that fence.
  • THOSE ARE THE EXTREMES

As a widow with grown kids --- I work about 3 or 4 hours a day -- at the various levels I'm at --- there's some wiggle room --- but it's not as negotiable as most people might think.
  • I can't really keep my mental health and do mindless work.
  • BUT I also can't work as long as many people can.

For me personally --- I can understand why Thomas More in his work "UTOPIA" --- thought 4 hours of work a day would be ideal --- BUT I also understand that for other people that wouldn't make sense.

My body needs a lot of exercise and I need to connect to people because I'm so idiosyncratic and asynchronous.

So not only do I need at least an hour of exercise a day, I need dancing or music several times a week  --- to connect more with other people.

Further, there is a greater than average break between most activities.

Now that is me --- other people need different things and the point is this is not so much what people need for some IDEALIZED EXISTENCE --- it's what some NEURO-DIVERSE PEOPLE with GREATER SYSTEMIC INFLAMMATION need to FUNCTION so they don't get "SICK."

Now like a lot of "ACCOMMODATIONS FOR PEOPLE WITH DISABILITIES" --- this could probably benefit other people, too.
PREVIEW:  Translational Medicine Friday

Val's Note:  I'm NOT SKEPTICAL over the Long Term that we will ultimately be able to surpass some of these limits.

And PROGRESS IS BEING MADE.

BUT we're not there yet in many cases, but we're often PRETENDING we are.
Val's Take/Conjecture

I am gonna continue my bitching about the Mental Health Profession in this but I'm gonna include Legal --- Criminal Justice as well and maybe some other aspects of "STREET LAW."

I don't think "DISABILITY LAW" is where it needs to be when it comes to "COGNITIVE DISABILITY" --
  • but I think it is generally closer to "REALITY" than a lot of what we're doing.

The Mental Health Profession --- OMG!
  • Once you realize that most people in the mental health profession don't want to work with people with "developmental disabilities"
    • You realize what a nightmare scenario this can be.
 
  • Further, these "developmental issues" are coming in the context of "SENSORY PROCESSING" and literally CELLULAR "REACTIVITY"
    • not necessarily in a lower IQ.
 
  • BUT if we're EQUATING EXECUTIVE FUNCTIONING with IQ that is likely to do MORE HARM THAN GOOD.
 
  • In fact --- IQ or some type of Special Ability or Special Interest --- may be HIGHER THAN THE NORM.
 
  • I think this is also a CLUE as to why we have really struggled to define INTELLIGENCE  ---
    • I think it can come wrapped in some idiosyncratic SENSORY PROCESSING.
 
This Has Some IMPLICATIONS for our CURRENT INTELLECTUAL LIMITS
  • a lot of who we study in school are neuro-diverse people who had some big strengths and some surprizing challenges.
  • trying NOT to ROMANTICIZE that is important
  • HIERARCHY doesn't really work that well to manage the strengths and challenges of almost 8 BILLION PEOPLE.

I'm NOT A TRUE BELIEVER in Mental Health's "PRO-SOCIAL COMPETENCY" Religion
  • --- even though I consider myself extremely "PRO-SOCIAL."

CRIMINAL LAW but also FAMILY LAW  ---
  • has been experimenting with some DIFFERENT MODELS
    • Problem-Solving Courts
    • Collaborative Law
  • We're needing to add to these models a PUBLIC HEALTH APPROACH that is EVOLVING ---
    • and may not be what we have traditionally thought in this area.
Translational Justice Monday

Neuro-Diversity, Biology and Authenticity

Beyond the LIFE-STYLE CHOICE and TRY HARDER
Val's Take
  • If there is any group of Neuro-Diverse People who is being BULLIED right now ---
    • it is certainly TRANS PEOPLE.
 
  • But it goes much beyond TRANS PEOPLE to ANYBODY with a "BIOLOGY" or "TRAIT COMBINATION" that is poorly understood --- and the "ANSWER" is often "TRY HARDER."
 
  • When I use the term "Neuro-Diversity" --- I'm generally referring to people with:
    • MORE DEVELOPMENTAL INFLAMMATION
    • Dysregulation of Multiple Systems of the Body:
      • the Immune System
      • the Endocrine System
      • the Microbiome
      • the Metabolism
      • the Brain and Central Nervous System
 
  • More Reactive Cells
  • Ramped Up Stress Responses
  • Hyper-Connected Brains
 
AND THIS CAN BE ON OPPOSITE ENDS of VARIOUS SPECTRUMS --
  • meaning some of these BULLIES ARE NEURO-DIVERSE.
 
  • We're also needing to come to terms with some PROBLEMATIC BIOLOGY without resorting to INHUMANE TREATMENT or GENOCIDE ---
    • When the BIOLOGY is better understood than it ever has been, and
    • There are STILL QUESTIONS
 
  • The BIOLOGICAL BASIS OF LIFE AND BEHAVIOR seems so SELF-EVIDENT --
    • But the LESS CONTROL one has over that --
      • The SCARIER THAT CAN BE FOR PEOPLE.
 
  • We are in a moment in HISTORY when we are gaining a lot more control and understanding of our own BIOLOGICAL PROCESSES ----
 
  • In many ways, the LGBTQ+ Community represents the EASY CASE ----
    • we're generally not talking about DANGER TO OTHERS.

  • The Hard Cases involve Danger to Self or Others or Gravely Disabled.
    • At least some to many of those cases can be PREVENTED with "SMARTER" Approaches and Work-Arounds.

  • Focusing on DEVELOPMENTAL INFLAMMATION rather than SYMPTOM CLUSTERS is more ACCURATE and also underscores our COMMON HUMANITY.
 

Olmstead Law & Order Thursday


Supported Employment & Entrepreneurship

for People with an IQ over 70 & Executive Functioning Challenges
Val's Take
  • We are SOCIAL ANIMALS
  • Neuro-Diverse people can BURNOUT, MELT-DOWN or BREAKDOWN for a number of reasons---
    • RIGHT UP THERE is having EXECUTIVE FUNCTIONING CHALLENGES ---
      • the Person doesn't understand
      • the Family doesn't understand
      • and the Society doesn't understand.
 
  • For a people with an IQ Over 70 and Executive Functioning Challenges ---
    • their very being is often judged as "UNREASONABLE"
 
  • With regard to the demands of EXECUTIVE FUNCTIONING ---
    • There is a need to SLOW DOWN and take some time to figure out how to work "SMARTER" in NON-NEURO-TYPICAL WAYS.
    • Now Neuro-Diverse People are DIVERSE and there will be the need for INDIVIDUAL TAILORING, but ----
    • Bringing in "ADHD," "AUTISM" and "GIFTED" Academic and Peer Experts could help facilitate more effective approaches:
      • To me you could think of this as another aspect of OPEN DIALOGUE.
 
  • What's driving the EXECUTIVE FUNCTIONING CHALLENGES I think is often also related to the STRENGTHS & WEAKNESSES of --
    • "HYPER-CONNECTED BRAINS"

So on the one hand there's a need to SLOW DOWN and address Executive Functioning.

ON THE OTHER HAND ---
  • There's also a need to SLOW DOWN and assess what LEVEL do they need to be working at when it comes to some type of:
    • "SPECIAL ABILITY" and/or "SPECIAL INTEREST"
 
Accommodating "ASYNCHRONY" in Employment has NOT BEEN EASY, especially when we didn't know how to do it.
  • that is CHANGING.

Most people will make the "ACCOMMODATION" or "WORK-AROUND" if they know what to do and it is not COST PROHIBITIVE.

There is a role for Olmstead Planning and Policy Making to INTEGRATE ASYNCHRONOUS People into the WORK FORCE.

Preview: Neuro-Diversity Wednesday
Intellectual Disability & IQ Over 70

For people with neuro-developmental & psychiatric disorders and an IQ over 70 ---
  • I would submit they need pretty much the same things as people with an Intellectual Disability and IQ under 70 ---
    • But tailored to their specific higher intellectual needs

The American Psychiatric Association lists the following needs for people with Intellectual Disability --- I'm adding some of the MODIFICATIONS I think need to be there for Neuro-Diverse People with an IQ Over 70:
  • Early intervention (infants and toddlers).
  • Special education.
    • Providing Specialized Educational Support for "gifted"/asynchronous kids is at least theoretically recognized in Education.
  • Family support (for example, respite care support groups for families).
  • Transition services from childhood to adulthood.
    • I'm 60 years old and some of the Senior Neuro-Diverse People I'm running into could use those TRANSITION SERVICES ---NOW.
      • Couldn't we all.
  • Vocational programs
    • This is a HUGE ISSUE
    • For Neuro-Diverse People with an IQ over 70-- you have to INCLUDE THEM in the STRUCTURE & DESIGN ---
      • Because they may be "SMARTER" than anybody in the room
      • Even if they are struggling with
        • Short Term Memory
        • Sensory Processing Issues
        • Organization
        • Emotional Regulation
        • Etc.
      • BUT DON"T MAKE THEM MINI OR LARGE-SCALE DICTATORS
        • Even if they think they are BENEVOLENT, they generally aren't.
  • Day programs for adults.
  • Housing and residential options.
  • Case management.

Our Mental Health Crisis and our Addiction Crisis are putting into HIGH RELIEF that Neuro-Diversity is becoming much more the NORM than the EXCEPTION.

Further, I think DEVELOPMENTAL INFLAMMATION DRIVES IT --- BUT that can be many things and many combinations of things.

The Society has largely thought it didn't need to make ACCOMMODATIONS or WORK-AROUNDS or EXPLICIT GUARD-RAILS for Neuro-Diverse People with an IQ over 70:
  • that just hasn't turned out to be the case
  • further we've been using Unconscious Bias, Hierarchy and our spoken and unspoken CASTE SYSTEM to manage ---
  • a great deal of HUMAN COMPLEXITY
  • See also Isabel Wilkerson's "Caste -- The Origins of our Discontents"

The Bottom Line is it IS WORSE TO BE AT THE BOTTOM OF THE SOCIAL HEAP:
  • But if we're NOT CAREFUL --- we're just playing MUSICAL CHAIRS
    • That's becoming very obvious to a lot of people in 2023
  • "EQUALITY" is part of the WAY OUT
    • But we're NOT CLONES
    • Equality of What?
      • What works for me --- doesn't work for others --
      • And what works for them --- doesn't work for me.


Translational Justice Monday

A Prescription for FEDERAL LEADERSHIP
  • Get States on Plans of Correction to Comply with Olmstead
  • Integrate Mental Health with the rest of Physical Health
    • Most psychiatric disorders involve dysregulations of mulitiple systems of the body --- the BRAIN + the Immune System, the Endocrine System, and the Microbiome.
  • Ramp up integrated RESEARCH and Translational Research to Clinicians and the Public.

This is a little bit of the FLIP SIDE of "NO FUNDAMENTAL ALTERATION DEFENSE WHEN BRINGING EXISTING MODELS TO SCALE."

The "Fundamental Alteration Defense" is a defense for States under Olmstead.

For example, the US Dept. of Justice has found that there is no fundamental alteration defense for STATES when bringing existing models of ASSERTIVE COMMUNITY TREATMENT and SUPPORTIVE HOUSING to SCALE.

The LEADERSHIP PRESCRIPTION for the FEDS is not really new ---
  • The Feds are trying to do what we have prescribed at least on some level.
  • It is really bringing the efforts to SCALE with the LEVEL of the CHALLENGE.
Preview:  Olmstead Law & Order Thursday

Are Outdated Mental Health Conceptualizations & Treatments an Olmstead Issue?

Val's Take
  • Often we would think of failure to keep up with or synthesize information in a field as a professional liability issue.
  • That doesn't really make sense in 2023 when:
    • you have many health care providers over-worked and experiencing or vulnerable to BURNOUT.
    • AND the National Institutes of Health, including the National Institute of Mental Health, struggling to synthesize the enormous qualities of information that have been generated and are being generated.
 
  • Title II of the Americans with Disabilities Act (ADA) applies to STATE and Local Governments and Olmstead is applying to STATES.
    • Olmstead holds that UNNECESSARY INSTITUTIONALIZATION of People with Disabilities violates Title II of the ADA.
    • States have a DEFENSE if they have a COMPREHENSIVE, EFFECTIVELY WORKING PLAN TO PROVIDE for people with disabilities in the community:
      • WAITLISTS MOVING AT A REASONABLE PACE
    • Olmstead does not require a "FUNDAMENTAL ALTERATION" of the State's Plan ---
      • Bringing existing models to SCALE is not a FUNDAMENTAL ALTERATION, according to (US Dept. of Justice) DOJ Findings Letters.
 
  • Right now large institutions and housing are largely "legally" STATE RESPONSIBILITIES --
    • and the FEDS chip in but there is NO ENTITLEMENT
    • Especially with regard to Housing for PEOPLE WITH DISABILITIES --- this becomes a kind of UNFUNDED MANDATE under Olmstead to the STATES under MEDICAID.
 
  • We really NEED those NEW UNDERSTANDINGS & TREATMENTS because the COST of HIGH NEED COGNITIVE DISABILITY is quite high in 2023.
   
  • It might be a TITLE V issue under the Rehabilitation Act of 1973 which prohibits discrimination against people with disabilities that receive FEDERAL FINANCIAL ASSISTANCE.
    • Right now we have a Medicaid Program that is often DISCRIMINATING AGAINST those with Psychiatric Disorders in the GREATEST NEED by FAILING TO FUND:
      • Institutes of Mental DIsease and
      • HOUSING
 
  • We need the Feds to:
    • Fund "Institutes of Mental Disease" and HOUSING under MEDICAID for people with Disabilities needing long term care and at risk of HOMELESSNESS and/or INCARCERATION, and
    • Ramped up FUNDING for NIH, including NIMH, to SYNTHESIZE and translate enormous amounts of information to CLINICIANS and the PUBLIC.
Sexual differentiation of the human hypothalamus:

Relationship to gender identity and sexual orientation (2021)

Affiliations
  • 1 Department Neuropsychiatric Disorders, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
  • 2 Department of Neurobiology and Department of Neurology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; NHC and CAMS Key Laboratory of Medical Neurobiology, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China

Mechanisms involved in sexual differentiation of the brain include hormones, genetics, epigenetics, endocrine disruptors, immune response, and self-organization.

Furthermore, structural and functional differences in the hypothalamus relating to gender dysphoria and sexual orientation are described in this review.

All the genetic, postmortem, and in vivo scanning observations support the neurobiological theory about the origin of gender dysphoria, i.e., it is the sizes of brain structures, the neuron numbers, the molecular composition, functions, and connectivity of brain structures that determine our gender identity or sexual orientation.

There is no evidence that one's postnatal social environment plays a crucial role in the development of gender identity or sexual orientation.
UNIVERSITY OF COLORADO
PREVIEW:  Translational Justice Monday

Moving Forward on a
CO Olmstead
Pro Bono Project

Val's Take
  • I've spoken briefly to CCDC (Colorado Cross Disability Coalition) in the FALL about this
    • I "think" they like the idea of including PEER ADVOCATES in the PROJECT
    • I "think" they have a lot of POLITICAL CONSIDERATIONS.
 
  • I spoke with Disability Law Colorado in November with the idea that I would set another meeting in February --- I'll be doing that.
 
  • I also intend to begin conversations with the ACCESS TO JUSTICE COMMITTEE with the Colorado Bar Association.
 ---Preview:  Neuro-Diversity Love and Relationships

The Perils of Using "Reasonableness" &/or Past Experience as a STAND-IN for

"I Don't Know"

Val's Take
  • Executive Functioning, Metabolic Differences, Ramped Up Stress Responses, Speech Gifts and Deficits, etc.
AND
  • Some BIG SUBSTANTIVE STRENGTHS

[Hyper-Sensuality:  I'll deal with next week -- BUT I think the Denver Art Museum's Sinners, Saints, Lovers & Fools --- gets pretty close to the truth ---
there's nothing quite like being Hyper-Sensual and Hyper Self-Conscious at the same time.]

Executive Functioning Differences
  • My own belief is that many of these EXECUTIVE FUNCTIONING DIFFERENCES are driven by the DEMANDS OF GREATER PROCESSING:
    • Short Term Memory Issues
    • Planning
    • Decision-making
    • Organizational Issues
    • Emotional Regulation
      • Those HYPER-CONNECTED LOGICAL BRAINS are ironically requiring special care to avoid MELTDOWNS, PANIC ATTACKS, BURNOUTS and/or BREAKDOWNS
    • And just to make it more fun --- this is coming in all kinds of COMBINATIONS.


Past experience of most people would say ---- MOST PEOPLE DON'T NECESSARILY HAVE THESE ISSUES
  • Therefore, if you do have these issues --- IT IS NOT REASONABLE
  • AND/OR --- you can't have any really big STRENGTHS OR TALENTS
  • For the ASYNCHRONOUS PERSON DEPENDING WHERE THEY HAVE LANDED in the SOCIAL HIERARCHY and what their STRENGTHS and WEAKNESSES actually are and what the ENVIRONMENT is like---
    • May believe they are BETTER than other people
    • WORSE than other people
    • That some people are just BETTER and WORSE than other people

It is really from having been surrounded by ASYNCHRONOUS PEOPLE all my life that I know there are SOME BIG STRENGTHS, SOME BIG WEAKNESSES --- and they are:
  • NOT THE SAME
  • they are INDIVIDUAL

I'm going to take a step back and make what may seem like some fine distinctions ---- but are actually CRITICAL to understanding Human Behavior.

Further, CLARENCE DARROW made one of those FOUNDATIONAL distinctions in 1903 in an address to the inmates of Cook County Jail in Chicago --- now recognized as probably the largest Mental Health Institution in the country:
  • "In one sense we're all equally good and equally bad --- we all do the best we can under the circumstances."
I would say there are at least 4 BIG CATEGORIES of "CIRCUMSTANCES" people are contending with:
  • one's own biology (which is NOT ALL HUMAN btw)
  • the biologies of the people around them (again NOT ALL HUMAN)
  • the social environment
  • the physical environment (including toxins)
At some point, I think Stanford Professor Robert Sapolsky's 2017 book "Behave" is going to be one of the milestones and privotal events in the process of changing our understanding of human behavior.

Beyond that --- IT'S NOT JUST THE BRAIN, IT'S NOT JUST "NEURAL."
 Neuroscientist and Author Antonio Damasio explains why the mind encompasses more than the brain.
In 2023 --- we're looking at something like Psycho-Neuro-Immuno-Endocrine-Microbiome-ology to understand HUMAN BEHAVIOR

Further, the IMMUNE SYSTEM is starting to take CENTER STAGE in way nobody anticipated.
  • I think the IMMUNE SYSTEM is having a moment because nobody expected this
  • The Immune System is connected to all those other systems as well
 
  • BUT the real story is that these systems are working in COMPLEX WAYS we're STILL DISCOVERING in 2023.
Back to RELATIONSHIPS
  • How we understand the difficulties we ourselves are having or other people in our lives ---- MATTERS
  • A lot of ENERGY & RESOURCES can be WASTED on trying to PUNISH someone ---
    • With regard to PARENTING --- I think parents have not all the resources they need BUT I think are now less likely to PUNISH a child for some kind of processing difference.
    • For ADULTS --- its much more COMPLICATED --- some of those ADULTS can be in positions of POWER
      • Both Clinton & Trump seem very ASYNCHRONOUS to me and I don't think our HIERARCHICAL SOCIETY served them well.
      • Putin may currently have PARKINSON'S DISEASE which is sometimes associated with GIFTEDNESS/ASYNCHRONY and is also associated with LEWY BODY DEMENTIA.
      • Further, it is not just WORLD LEADERS that can have cognitive problems --- at least some of us have worked for people who had some kind of cognitive issue and because they had POWER -- it was going to be pretty hard to do anything about it.
        • Because cognitive issues can be so widespread and we tend to focus on STEREOTYPES ---
          • I don't know how realistic it is to try BANISH every person with a cognitive issue--
            • I think it is more about AWARENESS and structuring things so that Strengths are built upon and Weaknesses are Compensated for.
            • See Composing to Avoid Cacophony
  • Often for people with fewer resources, punishment is particularly irrational when those resources are needed for HEALTHCARE, PLACEMENTS, HOUSING, EDUCATION, SUPPORTED EMPLOYMENT/ENTREPRENEURSHIP, etc.

HISTORICALLY --- we haven't had all this information, and even though there have been VISIONARIES for thousands of years --- all the dots weren't connected. 

Those dots are still not all connected ---- BUT we are IN THE PROCESS of taking a MORE WELLNESS and HEALTH BASED APPROACH to ourselves and others with the goal of INCREASING OUR CONTROL OF OURSELVES and moving to MORE SOPHISTICATED VIEWS that get us out of the FREE WILL vs. DETERMINISM STALEMATE.


PREVIEW:  Translational Medicine Friday

NO Competent Health Care System If We Don't Understand
Developmental Neuro-Inflammation

& We Certainly Won't Have a Competent Mental Health System If We Don't Understand Developmental Neuro-Inflammation ---

Val's Take
  • We are spending an ENORMOUS amount of money on HEALTHCARE in this Society.
  • One of the go to BROMIDES is --- WE NEED MORE PERSONAL RESPONSIBILITY
  • We have often thought that our CHRONIC DISEASE EPIDEMIC is a result in large part of people NOT TAKING PERSONAL RESPONSIBILITY.
 
  • At the same time we're coming to terms with:
    • The CONTRADICTIONS inherent in BOTH SIDES of the PRO LIFE DEBATE, and
    • The DEVELOPMENTAL ORIGINS of many BEHAVIOR ISSUES.
      • Those DEVELOPMENTAL ORIGINS are often SEX SPECIFIC and can be more obvious in males;
      • BUT the DEVELOPMENTAL ORIGINS often involve MATERNAL IMMUNE ACTIVATION (MIA)
 
  • There are probably a lot of proteins of 20,000 that are disrupted by Maternal Immune Activation ---
    • C-Reactive Protein is a protein that keeps coming up with regard to Neuro-Developmental & Psychiatric Disorders
    • Mayo Clinic --- C-Reactive Protein Test as relates to Heart Disease
PREVIEW:  Olmstead Law & Order Thursday

A Strict Constructionist Supreme Court and Olmstead

Val's Take

In the US Supreme Court's recent decision denying VETERAN'S DISABILITY BENEFITS due to late filing even under extremely compelling facts involving schizophrenia, bipolar disorder and tardive dyskinesia ---
  • The Supreme Court may be signaling that they are not going to play favorites --- or they at least want to be perceived that way;
  • "Dobbs" (last summer's decision overturning Roe v. Wade) was not an anomaly --
  • and strict constructionist views (both Constitutional and Statutory) are going beyond "THE RIGHT TO PRIVACY."

I could be WRONG --- but I don't see the current Supreme Court overturning Olmstead. YET.
  • BUT the little dance that advocates and states are required to do under OLMSTEAD is PROBLEMATIC.
  • Further, it is NOT CLEAR what the current Court would do with current US Department of Justice Guidance on OLMSTEAD.

I think most everyone likes OLMSTEAD IN PRINCIPLE --- just ask STATE OFFICIALS ---
  • BUT I think People with Disabilities Need MORE ACCESSIBLE ACCOUNTABILITY and
  • STATES need MORE MONEY and TECHNICAL SUPPORT from the FEDS even as we're maintaining FLEXIBILITY.

Back in 1999 when Olmstead was decided --- I don't think people were necessarily ready to get rid of the Medicaid Rule Prohibiting Medicaid Funding of "Institutes of Mental Disease."
  • BUT they also often hadn't been ready to acknowledge the numbers of people with brain injury, neuro-developmental disorders and psychiatric disorders in Jails and Prisons.
    • That has changed a lot, especially in the last 10 years.

Further, PERMANENT SCATTERED SITE SUPPORTIVE HOUSING is widely recognized as a VIABLE HOUSING & SERVICE MODEL for many people in a way that it wasn't 20 years ago even if some professionals knew about it.

I think if the FEDS were to get rid of the IMD Rule -- they need to STATUTORILY require States to develop Comprehensive Plans of Care, Placement and Housing for People with Disabilities who are Institutionalized or at Risk of Unnecessary Institutionalization with:
  • Measurable Goals
  • Reasonable Time Frames
  • and Funding to Support the Plan
SCOTUS’ First Decision of the Term Is a Unanimous Blow to Disabled Veterans

Why did the liberals co-sign Justice Amy Coney Barrett’s harsh opinion?

The Supreme Court's opinion in Arellano v. McDonough

What are some POTENTIAL OUTCOMES of INDIVIDUAL OLMSTEAD COMPLAINTS in the NEAR TERM?
  • Making A Record
  • Public Education
  • CREATIVE PROBLEM SOLVING


Virtual Histology of Cortical Thickness and Shared Neurobiology in 6 Psychiatric Disorders (2021)

JAMA (Journal of the American Medical Assn.) Psychiatry

Conclusions and relevance:   In this study, shared neurobiologic processes were associated with differences in cortical thickness across multiple psychiatric disorders. These processes implicate a common role of prenatal development and postnatal functioning of the cerebral cortex in these disorders.

[See Cleveland Clinic:  Cerebral Cortex]

Affiliations
  • 1 Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
  • 2 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
  • 3 The Hospital for Sick Children, Toronto, Ontario, Canada.
  • 4 Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
  • 5 Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles.
  • 6 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.
  • 7 Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
  • 8 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • 9 Department of Psychiatry, Yale University, New Haven, Connecticut.
  • 10 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
  • 11 University of Groningen, University Medical Center Groningen, Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, Groningen, the Netherlands.
  • 12 Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, Spain.
  • 13 FIDMAG Germanes Hospitalàries Research Foundation, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Catalonia, Spain.
  • 14 The Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, Ontario, Canada.
  • 15 Department of Pediatrics University of Toronto, Ontario, Canada.
  • 16 Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland.
  • 17 Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM.
  • 18 The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  • 19 Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology and Neuroscience; King's College London, London, England.
  • 20 Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy.
  • 21 INT UMR 7289, Aix-Marseille Université, CNRS, Aix-en-Provence, France.
  • 22 Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria; Centro de Investigación Biomédica en Red de Salud Mental, Santander, Spain.
  • 23 Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, the Netherlands.
  • 24 Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
  • 25 Department of Genetics, Instituto de Biociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
  • 26 The Research Institute of Pediatrics and Child Health of the Central Clinical Hospital of the Russian Academy of Sciences of the Ministry of Science and Higher Education of the Russian Federation, Moscow, Russia.
  • 27 Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
  • 28 University of Münster, Department of Psychiatry, Münster, Germany.
  • 29 Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
  • 30 Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy.
  • 31 Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.
  • 32 Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neuroscience, Amsterdam Neuroscience, Amsterdam, the Netherlands.
  • 33 Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Department of Psychiatry, Utrecht, the Netherlands.
  • 34 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.
  • 35 Department of Psychiatry, University of Basel, Basel, Switzerland.
  • 36 McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
  • 37 School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
  • 38 Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
  • 39 Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
  • 40 Department of Developmental Neuroscience - IRCCS Fondazione Stella Maris, Pisa, Italy.
  • 41 Department of Clinical and Experimental Medicine, University of Pisa.
  • 42 Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia.
  • 43 Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic, Barcelona, Spain.
  • 44 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); University of Barcelona, Spain.
  • 45 Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland.
  • 46 School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia.
  • 47 Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • 48 Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, England.
  • 49 Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, England.
  • 50 Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, Australia.
  • 51 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany.
  • 52 Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departamento de Psiquiatria, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain.
  • 53 Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London UK; Zurich Center for Neuroeconomics, University of Zurich, Zurich, Switzerland.
  • 54 Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota.
  • 55 Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, London, England.
  • 56 Orygen, Melbourne, Australia.
  • 57 Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands.
  • 58 IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
  • 59 Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
  • 60 Department of Psychology, School of Arts and Social Sciences, City, University of London, Northampton Square, Clerkenwell, London, England.
  • 61 Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany.
  • 62 Department of Psychiatry and Biological Sciences, Albert Einstein College of Medicine, the Bronx, New York.
  • 63 University Medical Center Goettingen, Department of Psychiatry and Psychotherapy, Systems Neuroscience and Imaging in Psychiatry, Göettingen, Germany.
  • 64 Department of Psychiatry, University of Tuebingen, Tuebingen, Germany.
  • 65 Behavioral Neuroscience Department, Oregon Health & Science University, Portland.
  • 66 Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York.
  • 67 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 68 Child OCD and Anxiety Disorders Program, Department of Psychiatry, University of Michigan Medical School, Ann Arbor.
  • 69 San Francisco VA Medical Center, San Francisco, California.
  • 70 Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.
  • 71 University of East London, School of Psychology, London, England.
  • 72 Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.
  • 73 Department of Neuroscience, Brighton and Sussex Medical School, Brighton, England.
  • 74 Tommy Fuss Center for Neuropsychiatric Disease Research, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
  • 75 Central Clinical Hospital of the Russian Academy Sciences, Moscow, Russia.
  • 76 Department of Psychology, Stanford University, Stanford, California.
  • 77 Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.
  • 78 Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
  • 79 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
  • 80 Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany.
  • 81 FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.
  • 82 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
  • 83 Department of Bioengineering, Imperial College London, London, England.
  • 84 Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
  • 85 Department of Biomedicine, University of Bergen, Bergen, Norway.
  • 86 Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia.
  • 87 University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, the Netherlands.
  • 88 Department of Experimental Psychology, Vrije Universiteit, Amsterdam, Netherlands.
  • 89 Genentech Inc, South San Francisco, California.
  • 90 Department of Psychology, University of Oslo, Oslo, Norway.
  • 91 Research Center for Child Mental Development, Chiba University, Chiba, Japan.
  • 92 Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco.
  • 93 University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands.
  • 94 Radboud University Medical Center, Karakter University Center of Child And Adolescent Psychiatry, Nijmegen, the Netherlands.
  • 95 Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland.
  • 96 National Institute of Mental Health, Klecany, Czech Republic.
  • 97 Department of Clinical Medicine, University of Bergen, Bergen, Norway.
  • 98 Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
  • 99 Department of Psychiatry and Psychotherapy, Philipps University Marburg, Marburg, Germany.
  • 100 University of Oxford, Oxford, England.
  • 101 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
  • 102 Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming. China.
  • 103 Research Institute of Pediatrics and child health of the Central clinical hospital of the Ministry of Science and Education, Moscow, Russia.
  • 104 Department of Psychiatry, Philipps-University Marburg, Marburg, Germany.
  • 105 Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
  • 106 Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
  • 107 Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany.
  • 108 Child Neuropsychology Section, University Hospital RWTH Aachen, German; JARA-Brain Institute II Molecular Neuroscience and Neuroimaging, Research Centre Juelich, Juelich, Germany.
  • 109 Department of Psychiatry and Psychotherapy, University of Bonn, Germany.
  • 110 Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
  • 111 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
  • 112 Mental Health Research Center, Moscow, Russia.
  • 113 Division of Molecular Psychiatry, Center of Mental Health, University of Würzburg, Würzburg, Germany.
  • 114 SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.
  • 115 Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil.
  • 116 Department of Biological and Medical psychology, University of Bergen, Bergen, Norway.
  • 117 Departments of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada.
  • 118 University Centre for Information Technology, University of Oslo, Oslo, Norway.
  • 119 Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia.
  • 120 Group of Research in Mental Health, Institut d'Investigació Biomèdica Sant Pau, IIBSant Pau; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
  • 121 Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
  • 122 Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • 123 Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
  • 124 McMaster University, Mood Disorders Program, SJH Hamilton, Hamilton, Ontario, Canada.
  • 125 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
  • 126 Department of Forensic and Neurodevelopmental Science, King's College London, London, England.
  • 127 Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College, London, England.
  • 128 Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston.
  • 129 OCD clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
  • 130 Department of Pediatrics, University of California, Irvine.
  • 131 Center for MR Research, University Children's Hospital, Zürich, Switzerland.
  • 132 Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
  • 133 Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, department of Pediatrics, Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
  • 134 Center for Neurobehavioral Genetics, University of California Los Angeles.
  • 135 Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  • 136 Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain.
  • 137 Neuroscience Research Australia, Sydney, Australia.
  • 138 Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, England.
  • 139 Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia.
  • 140 Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), and Center of Mental Health, University of Würzburg, Würzburg, Germany.
  • 141 Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland; Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Denmark.
  • 142 Department of Psychiatry and Human Behavior, University of California, Irvine.
  • 143 Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
  • 144 Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain.
  • 145 Priority Centre for Brain & Mental Health Research, The University of Newcastle, Callaghan, New South Wales, Australia.
  • 146 Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Germany.
  • 147 Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
  • 148 National Institute for Nuclear Physics, Pisa Division, Pisa, Italy.
  • 149 Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England.
  • 150 Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
  • 151 Center for Depression, Anxiety, and Stress Research, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
  • 152 Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Psicologia, Universidad Autónoma de Madrid.
  • 153 Neuroscience Research Australia, Sydney, New South Wales, Australia.
  • 154 Department of Child and Adolescent Psychiatry, RWTH Aachen University Hospital, Aachen, Germany.
  • 155 National Human Genome Research Institute and National Institute of Mental Health, Bethesda, Maryland.
  • 156 School of Psychology, Deakin University, Geelong, Melbourne, Australia.
  • 157 West Region, Institute of Mental Health, Singapore.
  • 158 Columbia University Irving Medical Center, New York, New York.
  • 159 Center for Child and Adolescent Mental Health, Institute of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
  • 160 Pediatric OCD Consultation Clinic, Anxiety Treatment and Research Center, SJH Hamilton, Ontario, Canada.
  • 161 Department of Psychiatry, New York University School of Medicine, Nathan Kline Institute, New York.
  • 162 Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
  • 163 Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut.
  • 164 Laboratory of Medical Physics and Magnetic Resonance - IRCCS Fondazione Stella Maris, Pisa, Italy.
  • 165 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands.
  • 166 Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.
  • 167 Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
  • 168 Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands.
  • 169 Academic Child Psychiatry Unit, Department of Pediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia.
  • 170 Hospital Clinic, University of Barcelona, Spain.
  • 171 Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Barcelona, Spain.
  • 172 Instituto ITACA, Universitat Politècnica de València, Valencia, Spain.
  • 173 Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
  • 174 Department for Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany.
  • 175 Department of Psychology, University of Bath, Bath, England.
  • 176 Clinical Translational Neuroscience Laboratory, University of California Irvine, Irvine, CA; Center for the Neurobiology of Learning and Memory, University of California, Irvine.
  • 177 German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany.
  • 178 University of California San Francisco, Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco, Weill Institute for Neurosciences.
  • 179 Department of Child and Adolescent Psychiatry, New York University Child Study Center, Hassenfeld Children's Hospital at NYU Langone, New York.
  • 180 Seoul National University Hospital, Seoul, Republic of Korea.
  • 181 Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.
  • 182 Departments of Human Genetics and Psychiatry, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
  • 183 Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
  • 184 Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud UMC, Nijmegen, the Netherlands.
  • 185 Donders Centre for Cognitive Neuroimaging, Radboud University Medical Centre, Nijmegen, the Netherlands.
  • 186 Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • 187 Department of Psychiatry, Amsterdam UMC, location VUMC, Amsterdam, the Netherlands.
  • 188 Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
  • 189 SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
  • 190 Psychology Department and Neuroscience Institute, Georgia State University, Atlanta, Georgia.
  • 191 Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Val's Take

COMORBITY involving Neuro-Developmental Differences/Disorders and Psychiatric Disorders
  • Maternal inflammation and its ramifications on fetal neurodevelopment. (2022)
    Trends in Immunology 
    Exposure to heightened inflammation in pregnancy caused by infections or other inflammatory insults has been associated with the onset of neurodevelopmental and psychiatric disorders in children.
  • Maternal immune activation generates anxiety in offspring: A translational meta-analysis. (2021)
    Translational Psychiatry. 
    Maternal immune activation (MIA) during pregnancy is recognized as an etiological risk factor for various psychiatric disorders, such as schizophrenia, major depressive disorder, and autism. ...The studies provide strong evidence that prenatal immune activation impacts specific molecular targets and synapse formation and function and induces an imbalance in neurotransmission that could be related to the generation of anxiety in offspring. Future research should further explore the role of MIA in anxiety endophenotypes. According to this meta-analysis, MIA plays an important role in the pathophysiological mechanisms of anxiety disorders and is a promising therapeutic target.
  • Maternal immune activation induces methylation changes in schizophrenia genes. (2022)
    PLoS One. 2022
    Susceptibility to schizophrenia is mediated by genetic and environmental risk factors. Infection driven maternal immune activation (MIA) during pregnancy is a key environmental risk factor.
  • Effects of maternal immune activation in porcine transcript isoforms of neuropeptide and receptor genes. (2021)
    Journal of Integrative Neuroscience                                             An association between maternal immune activation and neurodevelopmental and behavior disorders such as autism and schizophrenia spectrum disorders has been detected in long-term gene dysregulation.
One of the things that Paul Micallef with Autism from the Inside talks about are the LIMITS of EMOTIONS and ENERGY.

One of the things I don't think we talk enough about is the ENERGY part of that equation.

In the table below, I am going to be including HYPER-FOCUS and FATIGUE because it greatly impacts both RELATIONSHIPS and WORK --- and if you don't have RELATIONSHIPS and WORK --- you could find yourself INSTITUTIONALIZED or AT RISK OF INSTITUTIONALIZATION.
Mom on the Spectrum
Uneven Productivity

Val's Take:  I think this is a "Buddha Moment" when we need to wake-up to the widespread issue of cognitive disability in the human condition.

One of the things that is difficult is how many of these issues have DEVELOPMENTAL COMPONENTS that are impacting people with an IQ OVER 70. 

If we are focused on PUNISHMENT--- this becomes exceedingly problematic.

If we are focused on SAFETY --- it's not easy ---but all the blocks don't come crashing down --- and we have developed various certification procedures.

Further, the Americans with Disabilities Act and the Olmstead Decision could help us manage the HIGH END of the CONTINUUM OF CARE much better than we're doing ---
  • Olmstead is in fact geared to the HIGH END OF the CONTINUUM OF CARE ---
    • Those who are "INSTITUTIONALIZED" or at "RISK OF INSTITUTIONALIZATION."




Val's Take:  To me, Researchers in the US and around the world have made a prima facie case that there is "REASONABLE DOUBT" regarding our ASSUMPTIONS under Mens Rea (I'm not saying those researchers know they did that.)

And the question to me is --- Who Bears the Burden of Proof and Who SHOULD BEAR THE BURDEN OF PROOF.

Right now it appears we're putting that BURDEN on Indigent Defendants with Cognitive Disabilities --- when BILLION DOLLAR RESEARCH INSTITUTIONS are struggling with these questions.

I also think this raises questions of FUNDAMENTAL FAIRNESS, DUE PROCESS & EQUAL PROTECTION OF THE LAW --- now those are BIG US LEGAL CONCEPTS and they've been interpreted in complicated ways.

I do think we need to address the concerns of the DISABILITY COMMUNITY --- but ESPECIALLY when it comes to CRIMINAL JUSTICE --- we need people not only with LIVED EXPERIENCE OF DISABILITY -- BUT also LIVED EXPERIENCE of the CRIMINAL JUSTICE SYSTEM.
  • Those views are NOT MONOLITHIC anymore than other groups --- BUT there are often some different sensibilities that are often not heard.

For some people in Criminal Justice --- STIGMA cuts quite differently --- and dealing with a major health issue that is CRIMINALIZED --- that's a very destructive STIGMA that could mean HARD TIME or in some states the DEATH PENALTY.

More Later This Week

The beginnings of a TABLE regarding the Research on:
in Criminal Justice.

Will ultimately also look at co-morbidities.

These are broad categories and most people with these issues ARE NOT in the Criminal Justice System.
  • BUT . . . we do need to be focusing on these categories and get to MORE SPECIFIC BIOLOGY--

Getting to the SPECIFIC BIOLOGY needs to be approached CAREFULLY --- BUT it has the potential to demonstrate:
  • the effects of TRAUMA and ADVERSE CIRCUMSTANCES as well as
  • Better managing the PLAYING FIELD where we've often used HIERARCHY as a short-cut.

The other hope is that this will drive HEALTH CARE ADVOCACY on all sides.
PREVIEW Translational Justice Monday

Val's Take

I'm going to start work on --- Orchid's 2023 COLORADO COGNITIVE DISABILITY REPORT.

This is going to focus not only on Colorado but important research and projects in the US and Around the World regarding people with:
  • Brain Injury
  • Developmental Disability
  • Psychiatric Disorders, and/or
  • Substance Issues

in Criminal Justice.

Colorado is doing a lot of INNOVATIVE THINGS.

Like a lot of States we have a hard time funding the HIGH END of the CONTINUUM OF CARE:
  • Secure Therapeutic Placements
  • Non-Secure Therapeutic Placements
  • Scattered Site Supportive Housing (especially the Housing part), and
  • Supportive Employment/Entrepreneurship --- often ACCOMMODATING or WORKING AROUND Executive Functioning Challenges ---
    • While at the same time CHALLENGING PEOPLE in what can be HIGH STRENGTHS.

AT THE SCALE NEEDED.

These are absolutely STATE ISSUES --They are also FEDERAL ISSUES.

If you wanna know what it REALLY MEANS TO BE PRO LIFE --- THIS IS IT.
Picture

Colorado Justice Report

Winter 2022/2023
(sign up for the newsletter)
C-Reactive Protein during pregnancy is associated with different brain morphology, Autism, considered  a potential biomarker for psychiatric illness, a potential biomarker for ADHD, is associated with Schizophrenia, Bipolar Disorder and Depression. --- see further below
PREVIEW:  Translational Justice Monday

Val's Take
  • Medical Disciplines I think are more likely than the Legal Profession to engage in "ROOT CAUSE ANALYSIS" ---
    • It doesn't mean it's perfect, or
    • There aren't political considerations --
    • BUT they do try to make the effort
 
  • To even get to FUNDAMENTAL ROOT CAUSE ANALYSIS in especially CRIMINAL LAW --- we're often having to engage some kind of PUBLIC POLICY TASK FORCE ---- because so many INTERESTS are involved.
 
  • Colorado has had several of those kinds of TASK FORCES ---- often with elected public officials ultimately lamenting that they often didn't accomplish as much as most had hoped.
 
  • OLMSTEAD PLANNING is a lot of what's needed right now --- and is OUTCOMES FOCUSED with:
    • Measureable Goals
    • Reasonable Time Frames, and
    • Funding to Support the Plan.
 
  • In addition to ensuring that Criminal Justice, Law Enforcement and Individuals with Disabilities who are Homeless and/or Justice-Involved are included --- we also need to include:
    • Public Health Epidemiologists
 
  • Further, we need INTEGRATED HEALTH CENTERS OF EXCELLENCE that can address Health Effects over the LIFESPAN with regard to NEURO-DEVELOPMENTAL INFLAMMATION.
 
  • In Colorado that may mean a number of entities --- BUT it is for sure going to mean UC HEALTH.

I think entities like UC HEALTH could also engage in LARGE SCALE POPULATION STUDIES using AGGREGATE DATA that could help us further REFINE our understandings of what is going on with some of these complicated health issues that so many of us are struggling with throughout the SOCIETY.
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PREVIEW: Translational Medicine Friday

An examination of the association between altitude and suicide deaths, suicide attempts, and suicidal ideation among veterans at both the patient and geospatial level (Sept. 2022)
Highlights

•There is a significant correlation between altitude and suicide mortality rate for U.S. veterans.

•The association between altitude and suicide deaths is higher than the association with suicide attempts or ideation.

•Controlling for relevant factors improves the correlation.


Our work suggested that geospatial factors such as altitude may be significant and should be included in suicide prediction models. Future studies should incorporate altitude and other hypoxia-related variables into the suicide prediction models in order to further investigate how altitude and associated variables are related to suicide.
Affiliations
  • 1 Applied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
  • 2 Applied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
  • 3 Departments of Mathematics and Statistics, University of California, Los Angeles, CA, USA.
  • 4 Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, USA.
  • 5 Departments of Computer Science, Hood College, Frederick, MD, USA.
  • 6 VISN 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, PA, USA.
  • 7 Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
  • 8 Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA.
  • 9 Million Veteran Program, Department of Veterans Affairs, USA.
Val's Take/ Conjecture
  • Colorado Medicaid Providers might want to partner in a more STRUCTURED & SYSTEMIC Way to address issues of ALTITUDE and Mental Health with---
    • National Jewish Hospital in Denver
      • They are a national leader in respiratory work & have a SLEEP LAB.
    • My take has been if the COPING MECHANISM you need is OXYGEN ---- THERE REALLY is no SUBSTITUTE.
    • People should be screened for:
      • Deviated Septum
      • Allergies
      • Asthma
      • Sleep Apnea  --- sleep apnea can be due to a lot of things ---
        • Infant sleep apnea
        • Obstructive sleep apnea
        • Substance-Induced sleep apnea, and
        • Altitude induce sleep apnea
          • Sleep apnea has been associated with bipolar disorder according to Taiwan University.
      • Etc.
    • I think people can sometimes feel EMBARRASSED by these really MUNDANE ISSUES that could potentially lead to something more SERIOUS or Bizarre Behavior that's even MORE EMBARRASSING or WORSE.
    • I re-iterate I don't think the ONLY issue in Mental Health is ALTITUDE, SLEEP APNEA, etc. --- but I think this is an issue that helps explain why Mountainous Regions have significantly above Average Suicide Rates.
      • If we want to say there are other SOCIAL FACTORS --- that's fine --
        • BUT STOP IGNORING ALTITUDE and other Complicated Factors to getting OXYGEN to the BRAIN.
        •  There should be a SYSTEM OF COORDINATED CARE to have people evaluated for oxygen issues and screened for mental health issues. 
I would say an even greater obstacle is PARTIAL KNOWLEDGE --- and that is certainly the case in Mental Health today.
PREVIEW:  Neuro-Diversity Wednesday

What Is "MINORITY STRESS" ---???

thewell.northwell.edu › minority-stress Understanding The Weight Of Minority Stress | The Well by ...

"Minority stress is a type of stress felt by members of minority groups that involves emotionally taxing situations and experiences specific to one’s race, ethnicity, sexual orientation, and/or gender."
  • ETC.
Val's Take/Conjecture
  • I would say there is MORE going on here than we may realize.
  • Specifically, I think there are some POSITIVE FEEDBACK LOOPS that when we're under STRESS -----
    • We're becoming "MORE SENSITIVE"
    • We're RAMPING UP that SENSORY PROCESSING ---
      • Ostensibly --- so we can REASON and get out of the STRESSFUL SITUATION.
 
  • When you're in a COMPLEX SOCIETY and you're being MARGINALIZED ---
    • It is a long, hard road to get out of that --- that may SPAN GENERATIONS.
    • At that point --- we are into MATERNAL IMMUNE ACTIVATION.
 
  • LGBTQ+ are often Neuro-Diverse ---
    • Not everyone who is Neuro-Diverse is LGBTQ+
    • BUT the percentages of Non-Heterosexual People are HIGHER in Neuro-Diverse Populations ---
Ben Platt
Grow As We Go

I don't think Ben Platt necessarily meant what I see in this video --- which is 3 Neuro-Diverse People.

But whatever you see --- It's a beautiful song and a bittersweet video.
PREVIEW:  Translational Justice Monday

Genetic Testing, the Standard of Care & Individual Rights to Privacy & Access to Care

We're called on to Solve Some WICKED PROBLEMS involving Auto-Immune Disease, Cancer, Neuro-Developmental Differences, Psychiatric Disorders & Neurological Diseases

Val's Take/Conjecture

  • A lot of the problems we're facing are "WICKED PROBLEMS" of our own BIOLOGIES ---
  • It doesn't breakdown NEATLY into GOOD & BAD -- it's a POSITIVE in some ENVIRONMENTS --- a NEGATIVE in others.
  • AND WE'VE really got to UNDERSTAND what we're doing on BOTH the LARGE SCALE and the INDIVIDUAL SCALE.
  • SURVIVAL OF THE FITTEST --- is a pretty BLUNT INSTRUMENT ---
  • Further --- we all have pretty much the same genes and the greatest diversity is in the IMMUNE SYSTEM.
  • In the form we're in now --- the HUMAN BEING --- we're ALL OF THE BELOW:
    • TOP PREDATOR
    • A RATIONAL ANIMAL
    • Destroying the Planet ---
    • As we COMPETE against each other
  • It is BOTH an INSPIRING and DEEPLY TROUBLING PICTURE.
 
  • I remember a brilliant guy I knew who was also pretty weird and could be a jerk --- said, "I don't think my genes are that special."
    • I think that's true.
 
  • US vs. THEM THINKING is all around us and in many ways it may be LESS than what it was HISTORICALLY---
    • Further, there's a MUSICAL CHAIRS quality to "US vs. THEM THINKING"
    • Our "BALANCING ACT" is very much DEPENDENT on PUSHING "SOMEONE" to the BOTTOM
      • In the long run, that's not good for anyone ---
      • BUT it is especially not good in the short term for the person or group(s) -- that get pushed to the BOTTOM.
 
  • When it comes to NEURO-DIVERSITY --- at least in some cases what we're talking about is MORE REACTIVE CELLS.
    • Is that Good or Bad?
    • Well, it DEPENDS ---
      • On the Physical Environment
      • On the Diversity in our Microbiomes
        • One of the great insights of the 21st Century is that HUMAN REASONING & FUNCTIONING is DEPENDENT on NON-HUMAN "ACTORS"
      • On the Emotional Environment
      • On the Social Environment
      • A lot of what we think it is to be HUMAN is seen in the EXTREMES with Neuro-Diversity and Maternal Immune Activation.
        • A lot of the INDIVIDUALITY we see among HUMANS is the result of ---
          • GENETIC DIVERSITY in the IMMUNE SYSTEM, and
          • MATERNAL IMMUNE ACTIVATION.
 
  • Much of what the FREEWILL vs. DETERMINISM DEBATE gets WRONG is it is ROOTED IN THE PAST rather than LOOKING TO THE FUTURE.
 
  • We're all just BORN INTO THIS --- and if OUR SOCIETIES --- Don't KNOW or Don't have all the answers --- and they usually don't ---
    • That's often putting a HEAVY BURDEN on the INDIVIDUAL or GROUPS of INDIVIDUALS to FIGURE THINGS OUT.
 
  • CONFIDENTIALITY is a BAROMETER of whether we have things FIGURED OUT ---
    • IF WE'VE GOT THIS --- there's generally not a lot of ANXIETY about DISCUSSING a particular issue ---
    • IF We don't have this --- there's going to be a lot of anxiety about a particular issue
      • If we don't have this and there's a lot of anxiety --- SOME NEURO-DIVERSE PEOPLE are going to start pushing the ENVELOPE ---
        • Because they know IGNORANCE WON'T SOLVE THE ISSUE.
        • They may also know that we need to "SCRUB IDENTIFYING INFORMATION" until we do get this ---
        • Provide UNIVERSAL ACCESS to the CARE we do have, and
        • SLOWLY COME OUT OF THE NEURO-DIVERSE CLOSET ---
          • For our own Mental Health and that of others.





How The Black Death Shaped the Evolution of Immunity and Led to a Rise In Auto-Immunity (2022)
Science X:  Phys.org, Medical Xpress, Tech Xplore
Neanderthal DNA has Subtle but Significant Impact (2016)
Vanderbilt University

This is my year of "MAGICAL THINKING" --- Rick isn't literally GHOSTING ME --- but I do think about him a lot.

One of the things that Rick said when I forced him to listen to my BRILLIANT INSIGHTS on the IMMUNE SYSTEM:  "Well, if you think the brain is complicated --- Wait until you get to the Immune System."

It's been everything modern medicine could do to increase our understanding of INDIVIDUAL SYSTEMS OF THE BODY --- but these systems of the body don't work in ISOLATION --- those SYSTEMS OF THE BODY and the NOT SO HUMAN MICROBIOME are INTEGRATED.

How this plays out is extremely INDIVIDUAL and is DRIVING THE NEED FOR PRECISION MEDICINE. 
Translational Justice Monday

Federal Rule of Evidence 702.

Testimony by Expert Witnesses

A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if:

(a) the expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue;

(b) the testimony is based on sufficient facts or data;

(c) the testimony is the product of reliable principles and methods; and

(d) the expert has reliably applied the principles and methods to the facts of the case.


The Issue in 2022
  • Often mental health providers are "reliably applying" the principles and methods to the Defendant.
  • BUT --- those methods are NOT:
    • Based on sufficient facts or data,
    • The principles and methods are NOT RELIABLE.
      • If someone is getting an ANTI-SOCIAL PERSONALITY DISORDER DIAGNOSIS based on criteria from the DSM 5:
        • That is scientifically suspect.
        • Now, many of these categories are now being conceptualized as "BLURRED", and
        • Often related to Neuro-Developmental Differences or Disorders.
          • THAT SHOULD MATTER.

Further, it is muddy and messy:
  • our Legal System is currently not well structured to deal with the FALLOUT ---
    • If we raise legitimate questions about the reliability of "ANTI-SOCIAL PERSONALITY DISORDER" in the context of Criminal Justice and the ASSUMPTIONS we're making under MENS REA ---
      • Where does that leave us?

Honestly, with a system that is about 1/2 way there to a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE but doesn't have the PUBLIC HEALTH PRACTITIONERS to SEAL THE DEAL.

In 2022, the BIG QUESTION is who can live:
  • In the community, with some supports
  • In the community, with intensive supports
  • In a structured placement
  • In a secure placement.

Further, these questions are NOT somehow divorced from what COMMUNITY INTEGRATION is being provided for people with:
  • Neuro-Developmental Disorders
  • Psychiatric Disorders
  • Brain Injuries, and
  • Substance Issues that are often related to one or more of the above.

Do we even know what to provide in 2022?
  • Supportive Housing, and
  • Supportive Employment

could help a lot of people.

The INTEGRATION MANDATE of Title II of the ADA which also served as the RATIONALE for the US Supreme Court's 1999 Olmstead decision could provide the LEGAL BASIS.


Translational Justice Monday

I R Smart

I think when we talk about "INTELLIGENCE,"  "TALENT" or "HUMOR" we are often really talking about a RANGE OF SENSITIVITY TO THE ENVIRONMENT.

When we're talking about "ATHLETICISM" --- I think sensitivity to the environment AND particular types of body awareness.

This IDEA of a MEAN or a MIDDLE GROUND certainly goes back to Aristotle and maybe before him.

We're familiar with LAB TESTS which are looking for a CERTAIN RANGE --- not too high, not too low.

I would submit that many people with NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS are TOO HIGH in their "sensitivity to the environment."
  • They are too REACTIVE
  • That RAMPED UP SENSORY PROCESSING is stressing multiple systems of the body.
    • Including the STRESS RESPONSE

Further, when I say sensitivity to the ENVIRONMENT --- I mean sensitivity to the PHYSICAL, SOCIAL & EMOTIONAL ENVIRONMENT ---
  • So potentially greater sensitivity to:
    • TOXINS
    • ALLERGENS
    • SOCIAL ENVIRONMENTS
    • Etc.

RAMPED UP Emotional Responses to process RAMPED UP SENSORY INPUT.

It is important to recognize that INFLAMMATION is a UNIVERSAL LANGUAGE CODING FOR A LOT OF THINGS --- and that there are often GIFTS and CHALLENGES to SYSTEMIC DEVELOPMENTAL INFLAMMATION.
  • that lifting the VEIL OF UNCONSCIOUS BIAS ---
  • is EXPOSING
Picture

So that RAMPED UP SENSORY PROCESSING can look like:
  • *Genius or
  • *Talent

But it can also look like:
*Anti-Social Personality Disorder

I would submit the POWER of DIFFERENT is also the CHALLENGE of DIFFERENT ---
*Care needs to be taken
*Better Care Needs to be Taken
*Addressing Both Strengths & Weaknesses
*Not on the basis of "reasonableness" --- BUT on the basis of "REALITY"
Aurora Public Schools -- Aurora, Colorado (2018)

Twice Exceptional Students -- 2e

3:08:  "The most important piece to remember is to identify their strengths and program for that first.

"That's how a student will feel valued, engaged in the classroom and that they have a piece of the community they fit into.

"Then we can plan for their area of disability."


[Val's Note:   A WHOLE BUNCH of "GIFTED STUDENTS" are getting a LATE DIAGNOSIS of a NEURO-DEVELOPMENTAL DISORDER such as ADHD and/or Autism in ADULTHOOD.] 
Inflammation–

Nature's Way to Efficiently Respond to All Types of Challenges:

Implications for Understanding and Managing “the Epidemic” of Chronic Diseases (2018)
Later Today

Val's Take /Conjecture/Research

Working MORE on the Immune System & Cognitive Disability Table --- Substance Use Issues

On the one hand, a lot of people with RAMPED UP STRESS RESPONSES and/or PAIN RESPONSES are USING various SUBSTANCES to deal with that. 

On the other hand, some people are facing much more challenging circumstances.

I "think" one of the things that is happening with EPIGENETICS and the IMMUNE SYSTEM is that --- we're in a harsh environment (physical, social, emotional, etc.) and our IMMUNE SYSTEMS become more sensitive to help us deal with this.

The IMMUNE SYSTEM seems to be associated with SENSORY PROCESSING and with COGNITION. 

UK:  Assertive Community Treatment for Neurodivergent Clients (ADHD & Autism)
Attention Deficit Hyperactivity Disorder (ADHD) affects about 5% of adults.

However, 39% or more adults in adult psychiatry are misdiagnosed, particularly women labelled with personality disorders (Gerhand and Saville, 2021).

The large variability in reported estimates for autism makes it challenging to present an exact percentage.

However, reserved estimates propose that 1-2% of people are autistic (WHO, 2022), although the number of autistic adults is most likely more significant than traditionally reported (Bailey, 2022).

Still, therapists receive little or no training on neurodivergence; if training is delivered, they are commonly presented as 'other'.

Within national health services, neurodivergent referrals are often rejected as outside their remit, resulting in lacking exposure and experience among clinicians, who deliver interventions that are unhelpful and, at worst, traumatic (Young et al., 2021; Gore et al., 2022).
Val's Take/Conjecture
  • Both with Cancer and Auto-Immune Disorders, it took awhile to get a better handle on what was going on --- even as we often still can't "CURE" these problems --- although in the case of Cancer sometimes --- not always --- we can.
    • It was hard to know what to make of it ---
      • Was it a "Demon"
  • We don't tend to view things as "demons" anymore.
  • BUT there's a lot of "FAITH" in Human Agency -- even where that "FAITH" seems horribly misplaced.
  • There's a story on msn and probably a lot of the news sites of a woman who strangled and stabbed her daughter.
    • People with all their cognitive faculties don't do that.
  • BUT how is our society going to protect that little girl?
  • We don't have BIOMARKERS, we don't have a valid PSYCHIATRIC DIAGNOSTIC MANUAL.
  • Maybe we realize that PUNISHMENT isn't the ANSWER.
  • BUT what is the LONG TERM ANSWER?
  • It's better DIAGNOSTICS

  • The fact is we are on our way to better CONCEPTUALIZATIONS, DIAGNOSTICS and TREATMENTS.
  • BUT the ETHICS of what to do in the MEANTIME are NOT EASY.
Homeostasis as the Golden Mean
PREVIEW: 

Val's Note:  I'm still working on that letter to the American Bar Association regarding Anti-Social Personality Disorder, DSM Categories & the Criminal Justice System.
CBS Colorado

Eight Colorado district attorneys release years of data in push for judicial transparency. 

See Microsoft Public Safety & Justice.

This represents a true commitment to justice that will likely serve as a NATIONAL MODEL.

This Model needs to be adopted by States --- such as COLORADO --- with regard to OLMSTEAD COMPLIANCE.

Val's Note:

I'll be suspending regular features on the website until the Letter to the American Bar Association, Criminal Justice Section is completed.

The research and thought behind this draft letter is based on a lifetime of personal and professional experience as well as highly focused work as part of ORCHID the past 9 years.
  • I'll address problems with DSM Categories and the Reverberation in the Criminal Justice System
  • A fair amount of CONTEXT will be included regarding Research Concerns & Advances.
  • I'll be arguing for a PUBLIC HEALTH APPROACH to CRIMINAL JUSTICE in the LONG TERM and the need for INTERIM PROCEDURES in the SHORT TERM.
  • Further, I'll be arguing that "OLMSTEAD COMPLIANCE" is a CRIMINAL JUSTICE ISSUE.
[Parenthetically, Rick did agree with my approach focusing on SAFETY and adequate provision of HOUSING, PLACEMENTS & INTENSIVE SERVICES.

He also was quite skeptical of "PERSONALITY DISORDER DIAGNOSES" and he himself believed that such diagnoses were "UNSCIENTIFIC & VAGUE."

I was extremely influenced by Rick's opinion/opinions but I didn't always follow them.  Most of his CRITICISMS went to grammar or making sure I had explained an ACRONYM.

Given how SENSITIVE we both were ---this did not really work out:  I was doing the best I could just to get out the SUBSTANCE and wanted recognition for that --- and Rick would get in a SNIT if I didn't take his suggestions.

I finally just stopped asking him to save us both some grief.  In fact, he practically insisted on it --- since he refused to give me anymore feedback unless I agreed to accept all of it.

BUT ORCHID wouldn't be here without Rick and he begrudgingly funded it because he knew it would hurt me if he didn't.]
PREVIEW:  Olmstead Law & Order Thursday 

See:  Incarceration Rates for Native Americans
US Department of Justice (2021)
Voices from the Olmstead Decision
CITY of LAKE OSWEGO

"July 26th, 2022 marks the 32nd anniversary of the Americans with Disabilities Act! To celebrate this milestone, the City of Lake Oswego has released its ADA Self-Evaluation and Transition Plan for public review and comment. Learn all about the plan and how to provide feedback from ADA Coordinator, Kelli Byrd."

Val's Take
  • When we're talking about Accessibility with regard to Sidewalks or Parks --- we often are talking about a MUNICIPAL or LOCAL RESPONSIBILITY.
  • When it comes to ACCESS to INTENSIVE SERVICES that is often coming under MEDICAID which is a FEDERAL/STATE PROGRAM.
    • A State's Obligations under "OLMSTEAD" are NOT LIMITED to the MEDICAID Program.
  • "OLMSTEAD"  is a 1999 US Supreme Court Decision in which the US Supreme Court held that Title II of the ADA prohibits UNNECESSARY INSTITUTIONALIZATION of PEOPLE WITH DISABILITIES.
    • To me, the ADA is an example of the kind of PRACTICAL PRO LIFE LAWS we need.
    • SAFETY is important for PRO LIFE
      • PUNISHMENT and the Criminal Law are generally COUNTER-PRODUCTIVE
    • The Court evaluated this DUTY to PREVENT UNNECESSARY INSTITUTIONALIZATION in the CONTEXT of the STATE'S OVERALL "PLAN" for People with Disabilities.
  • HOUSING is often a component of US Department of Justice Olmstead Settlement Agreements with STATES.
    • The FUNDING of DISABILITY HOUSING is coming from MULTIPLE STREAMS---
      • HUD
      • State Housing Departments or Divisions
      • Municipalities, and
      • Philanthropic Efforts
  • When it comes to DISABILITY HOUSING under OLMSTEAD --- STATES have the ULTIMATE LEGAL RESPONSIBILITY.
    • We're for MORE HELP & FINANCIAL SUPPORT to STATES to DISCHARGE this LEGAL OBLIGATION.
    • Maybe the STATES, MUNICIPALITIES, COUNTIES, ADVOCATES, FAMILITIES & INDIVIDUALS need to PUSH the FEDS even more on FUNDING for HOUSING for People with Disabilities who are INSTITUTIONALIZED (including INCARCERATION) or are AT RISK OF INSTITUTIONALIZATION (including HOMELESSNESS).
  • MODELS of SUPPORTIVE EMPLOYMENT/ENTREPRENEURSHIP are also important and maybe something that TAXPAYERS and INDIVIDUALS with DISABILITIES need to:
    • BUILD IN FINANCIAL SUSTAINABILITY & RESILENCE
    • As well as MAINTAIN "Physical & Mental Health"
    • This may not be realistic for everyone, but probably is realistic for most people if STRENGTHS and WEAKNESSES (including EXECUTIVE FUNCTIONING differences) are practically addressed.
ADA National Network
Sex Differences in Autism Spectrum Disorder:   Focus on High Functioning Children and Adolescents (2021)
BELOW

"RELEVANT" in the LARGER SCHEME of THINGS videos as I clean up the Homepage.
Rocky Mountain PBS - Colorado Voices
Fighting Hunger -- June 2022

BLESSING BOXES & More

Val's Take
  • I think there are a lot of ways to get through HARD TIMES---
    • Music and
    • Religion
      • are often 2 common denominators
 
  • We're having Rick's Celebration of Life at the Episcopal Church because that really represented a "MIDDLE WAY" to Rick.
    • Rick grew up in a very strict Catholic family and after his divorce --- he wasn't interested in worshiping in a place in which he was considered a SECOND CLASS CITIZEN.
    • I'm all about the THEORY and the "IDEAS" behind religion or really anything and that would just drive Rick CRAZY.
      • "You Unitarians take religion WAY TOO SERIOUSLY."
      • For Rick it was about the:
        • Music
        • the Incense
        • the Liturgical Year
        • Order, and
        • Feeling part of something bigger than himself.
 
  • The last thing Rick was interested in was a THEOLOGICAL DISCUSSION ---THE END.

  • Of course, it's not quite THE END --- the grief but also the insights and mistakes will go on.
 
  • I've really made "RELIGION" a part of this website because "SCIENCE" is TOO SLOW.
    • Religion can be TOO SLOW if it can't keep up with SCIENCE.  
Why Humans Evolved to Play Music
Hint:  It's About Social Bonding

Religion for Breakfast (June 2022)
Rules Governing CO Medicaid's Community Mental Health Supports Waiver -- 8.509

Colorado's Administrative Procedure Act

C.R.S. Title 24 Government - State

Article 4 Rule-making and licensing procedures by state agencies

24-4-103. Rule-making - procedure - definitions - statutory citation correction. (1) When any agency is required or permitted by law to make rules, in order to establish procedures and to accord interested persons an opportunity to participate therein, the provisions of this section shall be applicable.

Except when notice or hearing is otherwise required by law, this section does not apply to interpretative rules or general statements of policy, which are not meant to be binding as rules, or rules of agency organization.


(1.5) If an agency reinterprets an existing rule in a manner that is substantially different than previous agency interpretations of the rule or if there has been a change in a statute that affects the interpretation or the legality of a rule, the office of legislative legal services shall review the rule in the same manner as rules that have been newly adopted or amended under paragraph (d) of subsection (8) of this section upon receiving a request for such a review of the rule by any member of the general assembly.
Who Has the BURDEN?
[This page has not been updated --- BUT the BASIC POINTS are still valid.]

​See Also:
 We're pulling a lot off the Home Page and transferring it primarily to:
In 2021, Psychiatric Disorders look BLURRED. 

Psychiatric Disorders and Neuro-Developmental Disorders look BLURRED. 

Personality Disorders and Neuro-Developmental Disorders look BLURRED.
Maternal Immune Activation

Val's Take
  • What I did UNDERSTAND was that Maternal Immune Activation has IMPLICATIONS for:
    • ​NEURO-PSYCHIATRIC DISORDER CLASSIFICATION
    • CLINICAL PRACTICE, and
    • THE LAW
Generic Olmstead Demand Letter to a State
[under construction]
The Rolling Heads in Colorado's Crappy Mental Health System

Orchid's 2022
CO Cognitive Disability 2-Pager
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BOTTOM LINE:  Colorado and other States need to get on with it and adopt REASONABLE PLANS with MEASURABLE GOALS to address BIG SHORTAGES.
Martin Scorsese on Citizen Kane

Orchid 2022 Olmstead Advocacy Efforts
How Many Angels Can Dance on the Head of a Pin?
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Free Will vs. Determinism?

Are those the right questions --- probably not.
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Lois Curtis -- one of the original plaintiffs in the landmark 1999 Olmstead Supreme Court Case
[Stakeholders are exploring the possibility of a State-supported process that would be looking to the 2023 Legislative Session]
World Mental Health Day
Sunday, Oct. 10, 2021

"During the World Health Assembly in May 2021, governments from around the world recognized the need to scale up quality mental health services at all levels."
ORCHID'S CO ADVOCACY ----- OLMSTEAD 2021 

​Translational/
​Transitional Justice Monday

NEURO-DIVERSITY WEDNESDAY
Olmstead Law & Order Thursday

Translational Medicine Friday

Translational Love, Relationships & Neuro-Diversity Saturday

Neuro-Diverse/Twice Exceptional, Oxygen Masks & the Need for Society to MAKE SOME SPACE
Reform of "Anti-Social Personality Disorder" in Criminal Justice
SAMHSA.GOV
 Veteran Transitional Housing Program --- Volunteers of America -- Colorado
"States are increasingly using community-based housing-related services as part of a strategy when implementing Olmstead plans or settlement agreements to provide integrated community living opportunities for people exiting institutional or other segregated settings, as well as those at risk of unnecessary institutionalization due to being inappropriately housed." ​
Satcher Health Leadership Institute at Morehouse School of Medicine (click image to go to website)

Double V over COVID-19

Stimulus for Supportive Housing &  Employment


CO HB22-1082

Establish Fair Housing Unit Department Of Law

Concerning the enforcement of state housing laws by the department of law, and, in connection therewith, establishing a fair housing unit within the department of law. 
Below via CO Department of Regulatory Agencies --
Civil Rights Division -- CO Law Forbids Discrimination in Housing
3 Olmstead Complaints                    that include a Request for Declaratory Judgment against:
  • Georgia
  • New York, and
  • Mississippi
 
  • Below:  Factual Allegations from each of the 3 complaints.
 
  • Also below:  a single document with the "Prayers for Relief."
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DOUBLE V

OUR 1-PAGER ON DISABILITY HOUSING & SUPPORTED EMPLOYMENT AS COVID ECONOMIC STIMULUS
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Colorado

  • CMHIP
Problems at Colorado's Primary Mental Hospital So Severe It Faces Potential Loss of Medicare (2021) 
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Colorado Springs Gazette
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  • Colorado Kids
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$76 million could fix Colorado’s youth mental health system, study finds as kids are sent out of state for care

“We don’t do this to kids with cancer.”   Residential treatment centers for youth have warned for years that they’re headed for collapse.

Why the Immune Connection matters ---- NOW

Val's Note:  I'll be adding links to Orchid Pages dealing with the Immune System and Mental Health.

We need professional and non-profit organizations to champion FUNDING of TRANSLATIONAL RESEARCH to mental health professionals.

Significant and PARADIGM SHIFTING CONCEPTUALIZATIONS are important in and of themselves with regard to STIGMA, Criminal Justice and access to Public Housing and Services.
  Shared Genes and Psychiatric Disorders

Karolinska Institute  in sweden ---

Psychosis Linked to brain's Immune System

DRAFT:  Innate & Adaptive Immunity in Cognitive Disorders
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Low social status 'can damage immune system'​ (2016)

Simply being at the bottom of the social heap directly alters the body in ways that can damage health, a study at Duke University in the US suggests.

Val's Take:  To me, what stands out is:
  • The IMMUNE SYSTEM is responding to much more than what we thought
  • The IMMUNE SYSTEM seems to be taking a "HOLISTIC APPROACH"  --- which may explain some of the CONFLICTING aspects of PSYCHIATRIC DISORDERS, namely a STRONG BIOLOGICAL COMPONENT as well as ACUTE SENSITIVITY TO THE SOCIAL ENVIRONMENT.​​  
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​Three Big Take Aways ​​
  • Cognitive and Social Abilities Rely on Fine-Tuned Equilibrium of Innate & Adaptive Immune Responses (2019)
  • Innate Immune Cells are Regulators of Brain Development & Behavioral Function​​​​ (2018)
  • The Vagus Nerve serves as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders.  (2018)
Val's Take
  • ​So the BIG NEWS is NOT so much that all COGNITIVE DISORDERS are IDENTICAL --- it's that the IMMUNE SYSTEM (INNATE and/or ADAPTIVE IMMUNITY) are involved in seemingly MOST if not all of COGNITIVE DISABILITIES.



Right now:  Proof Beyond A Reasonable Doubt is running headlong into some outdated COMPETENCY & INSANITY STATUTES.

While most people INTENDED THE CRIME --- Most People who COMMIT CRIMES have:
  • A Brain Injury, and/or
  • Substance Issues, and/or
  • Mental Illness, and/or 
  • Developmental Disabilities

that are greatly mediated by INNATE & ADAPTIVE INFLAMMATION affecting the Brain.​
Microglia and the Brain's Immune System
The Agenda with Steve Paikin -- Interview with writer Donna Jackson Nakazawa (Feb. 2021)

It's one of most paradigm-shifting and powerful stories in the history of medicine,, writes Donna Jackson Nakazawa. From MS to Parkinson's to Lupus and depression and schizophrenia the microglia, a tiny brain cell, is changing how we understand physical and psychiatric illness. Nakazawa joins to discuss her book, "The Angel and the Assassin: The Tiny Brain Cell That Changed the Course of Medicine."

"Microglia are involved in first line innate immunity of the CNS [Central Nervous System].... When activated, microglia can be potent immune effector cells, able to perform a broad range of functions, and they mediate both innate and adaptive responses during CNS injury and disease while remaining quiescent in the steady state."
Nov 18, 2009

​The Role of Microglia in Central Nervous System Immunity ...www.ncbi.nlm.nih.gov › pmc › articles › PMC3786731
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Substance Issues & the Immune System

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From Traumatic Childhood to Cocaine Abuse: The Critical Function of the Immune System (2018) 

Lo Iacono L, Catale C, Martini A, Valzania A, Viscomi MT, Chiurchiù V, Guatteo E, Bussone S, Perrone F, Di Sabato P, Aricò E, D'Argenio A, Troisi A, Mercuri NB, Maccarrone M, Puglisi-Allegra S, Casella P, Carola V.Biol Psychiatry. 2018 Dec 15;84(12):905-916. doi: 10.1016/j.biopsych.2018.05.022. Epub 2018 Jun 11.PMID: 30029767

METHODS: In this study, we performed a series of ex vivo and in vivo experiments in mice and humans to define the function of the immune system in the early life stress-induced susceptibility to the neurobehavioral effects of cocaine. RESULTS: We provide evidence that expo …
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Innate immune signaling in the ventral tegmental area contributes to drug-primed reinstatement of cocaine seeking.  (2018)

Brown KT, Levis SC, O'Neill CE, Northcutt AL, Fabisiak TJ, Watkins LR, Bachtell RK.Brain Behav Immun. 2018 Jan;67:130-138. doi: 10.1016/j.bbi.2017.08.012. Epub 2017 Aug 13.PMID: 28813640 

Cocaine addiction is a chronic relapsing disorder characterized by persistent perturbations to an organism's homeostatic processes that result in maladaptive drug seeking. Although considerable attention has been directed at the consequences of neuronal changes foll …
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Innate Immune Signaling and Alcohol Use Disorders. ​ (2019)

Coleman LG Jr, Crews FT.Handb Exp Pharmacol. 2018;248:369-396. doi: 10.1007/164_2018_92.PMID: 29500721 

Innate immune signaling is an important feature in the pathology of alcohol use disorders. ...In this chapter, we discuss the known contributions of innate immune signaling in the pathology of alcohol use disorders, and present potential …

community posting


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This will be moved to our page on
Art & Artists
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Grand Junction, Colorado

Orchid reports

Orchid's 2021 Colorado Cognitive Disability Report
Orchid's 2020 Colorado Cognitive Disability Report
Why States Fail to Comply with Olmstead 

Orchid's National Report on Selected Systemic Issues Leading to State Failure of Olmstead Compliance (cognitive disability) 2020
Our 2020 Report on --
​Anti-Social Personality Disorder & the Criminal Justice System
  

​VAGUE OLMSTEAD PLANS, EXPENSIVE LITIGATION --

THE NEED FOR REGULATORY OR STATUTORY CLARITY

 Public Health Approach
To Criminal Justice​

Science & Research
​Hot Topics --

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Thomas Kuhn, author of "The Structure of Scientific Revolutions" (1962)
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Podcast of King's College London
This may seem off key from our strong BIOLOGICAL focus, but we really see the Arts & Humanities as well as Doing Therapies  as a realistic compliment to traditional mental health treatment, namely medication & talk therapy.
National Institutes of Health (NIH) / National Institute of Mental Health (NIMH) -- 2018  

Maternal Inflammation & Baby's Brain

Claudia Buss, Ph.D., of Charité University Medicine Berlin and University of California Irvine, discusses research on inflammation in pregnant mothers and possible effects on brain development in their children.  

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