Blog Posts

When are we going to make the reforms necessary due to an invalid dsm 5?

3/29/2022

We're now about 9 years out from when Science 2.0 website announced that Dr. Thomas Insel then Director of NIMH gave the DSM 5 a "KILL SHOT" -----

It may be slow acting --- BUT it is slowly making its way through the System(s).

When you have SYSTEMS that are SO DEPENDENT on a particular WAY OF THINKING and that WAY OF THINKING is GREATLY CALLED INTO QUESTION---

Understanding there is a problem is just the FIRST STEP.

I think the problems associated with the DSM will ultimately be recognized right up there with the Copernican Revolution and Darwinian Evolution.

BUT both the Copernican Revolution and Darwinian Evolution went to RELIGION --- the PROBLEMS with the DSM are going to EMPIRICAL SCIENCE and its LIMITS---- especially if DIVORCED from:

REASON, and
HIGHER ORDER MORAL and ETHICAL CONSIDERATIONS

----Once you get RDOC (the National Institute of Mental Health's Research Domain Criteria Program)--- figured out --- we will start MODIFYING --- is not only NOT GOOD ENOUGH --- it's RIDICULOUS when it is not HORRIFIC.

May 3, 2013

By Hank Campbell

The National Institute of Mental Health (NIMH) is distancing itself from the the American Psychiatric Association and its upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

While they acknowledge that the goal of DSM "is to provide a common language for describing psychopathology" they are no longer convinced that approach has value if we are going to solve 21st century cognitive science problems.

It is, paraphrasing the statement of Thomas R. Insel, M.D., Director of the National Institute of Mental Health, more of a dictionary than a manual. He uses the term "Bible" instead of 'manual' but I would have used 'glossary' rather than 'dictionary'.

Insel pulls no punches in his statement on why they are not going to fund things based on DSM criteria any more.

"The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

This is a charge leveled at psychology as well, and the field in general, but psychiatry takes the biggest hits, because they are supposed to be the most evidence-based. Unlike psychology, psychiatrists have to be M.D.s first.

Writing in The New Yorker, Gary Greenberg tries to tackle why cognitive science hasn't kept pace with medicine, much less the physical and life and earth sciences, writing rather nicely that "it’s not entirely clear that psychiatrists want a solution to the problem."

Insel is more blunt. "DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever."

Basically, he says DSM is stuck in the past.

Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

Patients with mental disorders deserve better.

NIMH is leaving the past behind. In the past, Insel notes, they would reject a biomarker that did not match a DSM category. Now they instead want to collect how all data - genetic, imaging, physiologic and cognitive - cluster, and not just how symptoms do. They call it the Research Domain Criteria (RDoC) project.

"That is why NIMH will be re-orienting its research away from DSM categories.," he wrote, and that means funding applicants are going to have to adjust to the 21st century.

The APA may be outraged, and certainly some DSM-5 defenders, but I predict people in cognitive science who want to really do science and get NIMH funding are relieved that they are not going to have to cater to a document everyone seems to know was always flawed.

Read Insel's whole statement, Transforming Diagnosis, and have hope for the future.
Science 2.0

Hyper-Connected Brains --- What Does That Mean? And Why Can It Be Both A Blessing & A Curse?

3/24/2022

Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland

"Hyper-connectivity and hyper-plasticity in the prefrontal cortex implies hyper-functionality of one of the highest order processing regions in the brain, and stands in contrast to the hypo-functionality that is normally proposed in this region to explain some of the autistic symptoms.

"We propose that a number of deficits in autism such as sociability, attention, multi-tasking and repetitive behaviours, should be re-interpreted in the light of a hyper-functional prefrontal cortex."

Hyper-connectivity and hyper-plasticity in the medial prefrontal cortex in the valproic acid animal model of autism (2008)

-------Frontiers in Neural Circuits

1 Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
2 Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA

Medical Daily:
Kids with Autism have Hyperconnected Brains (2013)

BUT HYPER-CONNECTIVITY IS NOT JUST ASSOCIATED with AUTISM

it is associated with Depression
it is associated with Schizophrenia
it is associated with ADHD
it is associated with Bipolar Disorder
it is associated with Dyslexia
Etc.

https://www.frontiersin.org › articles

by F Morken · 2014 · Cited by 23 — Overall, the dyslexia group showed cortical hyperactivation ... group differences in brain areas associated with language processing as well ..

University of Pavia, Italy

hyper-connectivity between caudate and salience regions in ADHD fMRI at rest
...https://pubmed.ncbi.nlm.nih.gov › ...

by S Damiani · 2021 · Cited by 12 — Attention-Deficit/Hyperactivity Disorder (ADHD) comprises disturbances in attention, emotional regulation, and reward-related processes.

Further, this HYPER-CONNECTIVITY appears to be related in some ways to EPIGENETICS and INCREASED HUMAN VULNERABILITY to NEURO-PSYCHIATRIC DISEASES.

Georgia Institute of Technology

"Therefore, recent epigenetic evolution of human cortex has shaped the cellular regulatory landscape and contributed to the increased vulnerability to neuropsychiatric diseases."

Evolution of DNA methylation in the human brain (2021)

Pitzer College

"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)."

High intelligence: A risk factor for psychological and ...

Department of Psychology, Pitzer College, , Claremont, CA USA
Department of Industrial-Organizational Psychology, Seattle Pacific University, USA
Department of Research, Awesome Neuroscience, USA
Department of Psychology, Pitzer College, USA

Academic Medicine as the BRIDGE Between Research and the Clinician as well as the PUBLIC

3/17/2022

A lot of what we are about in the 21st Century is INTEGRATING KNOWLEDGE.

The more the RESEARCHERS DISCOVER ---- the more that has to be INTEGRATED with EXISTING KNOWLEDGE.
Traditionally, this has been a BIG ROLE of HIGHER EDUCATION.

One of the reasons we now have this HUGE DISCONNECT between RESEARCHERS and Mental Health Clinicians is we have NOT appreciated the COMPLEXITY and DIFFICULTY of integrating new understandings that absolutely are going to:

the brain, BUT are also going to
the IMMUNE SYSTEM
the MICROBIOME
METABOLISM, and
the Endocrine System

Like a lot in LIFE --- there's NO MAGIC WAND --- there's a lot of HARD WORK.

Now once we get "it" FIGURED OUT --- it's easy --- "OF COURSE"
BUT prior to that "it" is NOT SO EASY and NOT SO OBVIOUS.

IT takes TIME, ENERGY and MONEY to INTEGRATE NEW UNDERSTANDINGS and we need MESSENGERS people will TRUST --- and UNIVERSITIES help to provide that.

The Wizard of Oz (1939) --- Scarecrow Gets A Brain

Based on the book by Frank Baum -- The Wonderful Wizard of Oz (1900) and the subsequent series.

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

Epigenetics and Neuro-Developmental, Psychiatric Disorders & Auto-Immune Disorders

2/23/2022

So when we think about what are CAUSING NEURO-DEVELOPMENTAL, PSYCHIATRIC & AUTO-IMMUNE DISORDERS, the primary RESEARCH UNDERSTANDING which hasn't quite made it to CLINICIANS are:

Genetics --- BUT many genes are SHARED across "disorders."
Epigenetics
Environment

Further, many people with PSYCHIATRIC DISORDERS also have some form of AUTO-IMMUNE DISEASE with Thyroid Disorders being the "Tallest Tree in the Forest of POLY AUTO-IMMUNITY."

Further, many AUTO-IMMUNE diseases bring with them PSYCHIATRIC SYMPTOMS.

When we think about this from a PUBLIC HEALTH perspective, it's often EPIGENETICS and ENVIRONMENT that are powering our explosion of NEURO-DEVELOPMENTAL, PSYCHIATRIC and AUTO-IMMUNE DISEASES.

Further, we do seem to be becoming MORE SENSITIVE to OUR ENVIRONMENTS ----

More allergies, more food sensitivities --- that are in greater numbers than even a generation ago.
BUT we also seem to be more "EMOTIONALLY SENSITIVE" in more ways that are NOT just about getting better COPING SKILLS ---
- although everybody's doing what they can & probably should--- this "seems" more complicated than that.
- Further, while SOCIAL MEDIA may be part of the problem --- it's not clear its SUFFICIENT to explain everything -- especially when we start taking into account the EPIGENETICS of these disorders.

Epigenetic Mechanisms in Psychiatric Disorders --- Major Depression, Psychosis, Addiction (2021)

University of Maryland

Scientists Discover That Mating Can Cause Epigenetic Changes That Last for 300 Generations (2021)

We can't make the horrific errors that the 20th Century made with Eugenics & Genocide BUT we can't keep failing to appreciate the MAGNITUDE of the PUBLIC HEALTH CRISIS that widespread:

Neuro-Developmental Disorders
Psychiatric Disorders, and
Auto-Immune Diseases represent

This is A LOT MORE than 1 person getting his, her, their Sh** Together.

University of British Columbia at Vancouver

Disruptions of genes that are involved in epigenetic functions are known to be causative for several mental retardation/intellectual disability (MR/ID) syndromes.

Recent work has highlighted genes with epigenetic functions as being implicated in autism spectrum disorders (ASDs) and schizophrenia (SCZ).

Epigenetic Impacts on Neurodevelopment: Pathophysiological ...

Emory University School of Medicine in Atlanta, Georgia

Epigenetic Regulations in Neuropsychiatric Disorders - Frontiers https://www.frontiersin.org › articles

by JN Kuehner · 2019 · — In the mammalian CNS, epigenetic dysregulation is associated with neuropsychiatric diseases such as major depressive disorder (MDD), ...
‎
Abstract · ‎Regulatory RNA · ‎Major Depressive Disorder · ‎Autism Spectrum Disorders

Altered immune phenotype and DNA methylation in panic disorder (2020)

Chapter 25 - Epigenetics of Autoimmune Diseases (2020)

Although strong genetic bases have been found by genome-wide association studies, no unique genetic mechanism underlying immune tolerance breakdown was identified in autoimmune diseases.

The largely incomplete concordance rates of autoimmune diseases in monozygotic twins strongly support other complementary mechanisms involved in gene regulation ultimately causing overt autoimmunity, and it is becoming increasingly evident that epigenetic deregulation contributes to the emergence and/or the progression of disorders that include lupus, rheumatoid arthritis, systemic sclerosis, Sjögren’s syndrome, vasculitis, diabetes, and multiple sclerosis.

WHY IS THIS IMPORTANT?:

Auto-Immune Diseases, very much like Neuro-Developmental Disorders or Psychiatric Disorders were both:
- believed to be at one time "psycho-somatic" --- ALL IN YOUR HEAD
- they are not totally genetic
MS often has psychiatric symptoms as well and it is being more and more related to the Epstein-Barr Virus.
Neuro-Developmental Disorders and Psychiatric Disorders are more and more related to MATERNAL IMMUNE ACTIVATION.

Inflammation: The Modern Equivalent of Learning to Control FIRE

2/9/2022

Inflammation is so confusing --- its like a BABY crying --- that baby maybe crying for the usual reasons:
- hungry
- tired
- needs a diaper change, BUT
- it could be something else

To me, inflammation is like that baby crying ---- maybe there are different types of cries and different types of inflammation --- but it's this kind of UNIVERSAL SIGNAL that something is needing to be addressed.

In some ways, that CRYING BABY is more IMMEDIATE and EASIER to UNDERSTAND.

INFLAMMATION can not only build up over a period of years in a SINGLE LIFETIME --- it can build up over GENERATIONS.

One of the things that has made it HARD to UNDERSTAND is that we have IDEAS that there is a STRICT SEPARATION between our SOCIAL ENVIRONMENTS, PHYSICAL ENVIRONMENTS and our BIOLOGY
- So we've SEPARATED THINGS OUT to UNDERSTAND them.
- We haven't really understood the MAGNITUDE of INFLAMMATION because to do that we would have to INTEGRATE an ENORMOUS AMOUNT of KNOWLEDGE from areas and expertise we consider DISTINCT and SEPARATE.

So when we talk about PSYCHIATRIC DISORDERS that involve the BRAIN, but other SYSTEMS of the BODY as well, including the IMMUNE SYSTEM --- there are a lot of things that can damage the BRAIN's IMMUNE SYSTEM:
- Maternal Immune Activation
- Trauma
- Intergenerational Trauma
- Infections
- Toxins
- Not getting enough oxygen
- COVID
- Genes that go to the Immune System and Epigenetics
- etc.

Human beings aren't necessarily just contending with 1 of those things -- but multiple factors that are playing out in INDIVIDUAL and IDIOSYNCRATIC ways.

We've started the PROCESS of UNDERSTANDING the role of DEVELOPMENTAL INFLAMMATION in many people with PSYCHIATRIC DISORDERS and the role of EPIGENETICS.

So this is MORE COMPLICATED than we're treating it in our HEALTHCARE PROFESSION and in our PUBLIC POLICY.

"First Do NO Harm" --- is easy to say --- but it has proven hard to put into practice when multiple systems of the body are DYSREGULATED --- we're kinda just figuring that out ---- and we're at the beginning stages of IDENTIFYING BIOMARKERS.

The Society is looking to the MEDICAL PROFESSION and the HEALTHCARE PROFESSION to help NAVIGATE what can be a challenging ETHICAL & MORAL LANDSCAPE.

You wouldn't be the first person or first group of people to feel compelled to take a step back and say: Maybe our current judgments aren't completely accurate or fair.

Touched with Fire --- Manic Depressive Illness and the Artistic Temperament (1996) by Kay Redfield Jamison

Hair Analysis, Psychological Analysis, the Criminal Law & the Ethical & Moral Imperative to Pull Back

The Importance of Addressing Executive Functioning ---- from ADMINISTRATIVE SUPPPORT to Assertive Community Treatment

2/2/2022

For a long time, Mental Health along with everyone just considered challenges in Executive Functioning as problems with LACK of RESPONSIBILITY.

Where do I personally get the best appointment reminders ---my upscale Suburban Dentists' office.
- I get reminded 2 weeks before the appointment.
- 1 week before the appointment
- And the day before
- In the manner --- I prefer
  - The "WHAT I PREFER" part is important
  - It is also challenging for any medical or health care provider
  - Some automated systems do provide for choice in manner of communication:
    - E-mail
    - Telephone
    - Text
    - Some people may need an actual in-person contact --- that Suburban Upscale Dentists' Office is providing a lot of personal contact just as a good business practice for the BOTTOM LINE.
That doesn't just happen --- it's a COST
At this point in my mental health journey, what ADMINISTRATIVE SUPPORT the psychiatrist has is MORE IMPORTANT to me --- than who the psychiatrist is.
I know this was a BIG ISSUE in Colorado Medicaid a few years ago and may have been at least partly resolved.
In Private Mental Health --- the Solos are sometimes trying to perform their own Administrative Support at the same time they are charging out of network.
- I know I felt ripped off --- and I probably wasn't the only one.

Group practices and Corporate Mental Health generally have more in the way of Administrative Support --- but it is still often falling short of what one can get in other areas of the Society.

Beyond that --- it is a telling indication that the profession doesn't really understand that they should be LEADING on matters of accommodating Executive Functioning Differences and Deficits.

A COMMON PRESCRIPTION: Let's try to turn this person into a NEURO-TYPICAL often doesn't work and it can EXACERBATE things. WHY IS THAT?

Those EXECUTIVE FUNCTIONING DIFFERENCES are at least in part often DEVELOPMENTAL.
The BRAINS of People with Neuro-Developmental Disorders do become HYPER-CONNECTED as a way to try to COPE with various DIFFERENCES and DYSREGULATIONS.
By the time one gets to the MENTAL HEALTH PROFESSIONAL --- that's needing to be CALMED DOWN.

For some people with neurodevelopmental and psychiatric disorders, the Executive Functioning Support they need goes beyond APPOINTMENT REMINDERS which are really going to MEMORY and some other challenges related to DOPAMINE DYSREGULATION and other issues.

Part of EXECUTIVE FUNCTIONING is EMOTIONAL REGULATION.

This is also an issue where it is NOT FEASIBLE for the Psychiatrist or Counselor to try to bear the ENTIRE LOAD of that.

PEER SUPPORT can be an EQUIVALENT of ESSENTIAL ADMINISTRATIVE SUPPORT when it comes to providing EMOTIONAL SUPPORT.

This does get to why serving people with Executive Functioning Differences can be so CHALLENGING --- we don't want to burn anybody out and we don't want to BANKRUPT our SYSTEMS either.

That's why having a SOCIETY that is EXECUTIVE FUNCTIONING INFORMED is important.

In many cases, if we're providing A LITTLE BIT to MEDIUM SUPPORT --- IN MULTIPLE AREAS --- we can avoid the need for that total breakdown of functioning that is so costly PERSONALLY and FINANCIALLY FOR INDIVIDUALS, FAMILIES and THE SOCIETY --- to say "Hey, something isn't working here."

Further, we can't put this on just one segment of the society --- or they can breakdown too --- and that is part of what has happened with Mental Health.

On the FLIP SIDE ---- we not only have to engage others ---- we have to develop, reward and employ those UNEXPECTED STRENGTHS that often come with NEURO-DIVERSITY.

One of the reasons ASSERTIVE COMMUNITY TREATMENT is the gold standard of Intensive Mental Health Care:

It's addressing those MULTIPLE NEEDS that EXECUTIVE FUNCTIONING Differences and Challenges can present.

I love this video. It is from Canada and it's on Housing and Assertive Community Treatment.

One of the points the psychiatrist makes is --- You don't just get people better by seeing a PSYCHIATRIST --- you need this whole system of support.

I would submit the reason you need that whole system of support is to address DIFFERENCES and DEFICITS in EXECUTIVE FUNCTIONING.

If we are combining TRAUMA-INFORMED CARE with EXECUTIVE FUNCTIONING INFORMED CARE ---- we probably could do this more COST EFFECTIVELY.

Case in Point: The Biology of Substance Issues Meets "Us vs. Them Thinking" --- & A modern take on Loyalty & Fealty

1/22/2022

We're going to be looking at Substance Abuse and its relationship to Neuro-Endocrine and Neuro-Immune Pathways.

Also, the DISPARITIES with regard to DRUG ENFORCEMENT are fairly well established..

It's hard if not next to impossible to understand what is going on in this Country with regard not only to Criminal Justice BUT ALSO the Society At Large --- if you don't start addressing:

UNCONSCIOUS BIAS
US vs. THEM Thinking
and a Society of Lawyers, Advocates, and At Will Employees in which everyone has taken an OATH of LOYALTY & FEALTY --- and few are really free to speak their minds without fear of losing their jobs.
Further, educated professions such as LAW & Mental Health are making rudimentary logical mistakes --- but it is difficult to address if we're unwilling to address UNDERLYING ASSUMPTIONS that don't look so good anymore.

Tolstoy had an interesting REMEDY for US vs. Them Thinking and it was that God was on the SIDE of the UNDERDOG.

As soon as the UNDERDOG got the upper hand, it switched --- and God was on the SIDE of the NEW UNDERDOG.

I think one of the ways this is borne out in a way is that we are UNAWARE of our UNCONSCIOUS BIASES --- but those on the receiving end are AWARE --- and sooner or later that KNOWLEDGE is going to turn into POWER.

What Is the "Us Against Them" Mentality?

Effects of prenatal immune activation on amphetamine-induced addictive behaviors: Contributions from animal models (2021)

Abstract

Background: Prenatal environmental adversities may affect brain development and are associated with increased risk for schizophrenia, an illness with 50% comorbidity with addiction.

Maternal immune activation by poly-inosinic-citidilic acid (Poly(I:C)) exposure can promote behavioral alterations consistent with schizophrenia symptoms in rodents.

. . .

Conclusions: Prenatal administration of Poly(I:C) is able to potentiate vulnerability to addiction in two animal models, without however modulating stereotyped behavior.

Neuroendocrine and immune pathways from pre- and perinatal stress to substance abuse (2018)

Neuroimmune Mechanisms as Novel Treatment Targets for Substance Use Disorders and Associated Comorbidities (2021)

Do we have the right profession to address the "Neuro-developmental continuum"---?

1/16/2022

Genetic research supports the hypothesis that ID (Intellectual Disability), ASD (Autism Spectrum Disorder), ADHD, schizophrenia, and bipolar disorder lie on a neurodevelopmental continuum

There's a lot of "INTEGRATIVE COMPLEXITY" in the statement above from Dialogues in Clinical Neuroscience, and I suspect we will be UN-PACKING IT for the next century if not far beyond.

Much of how we REASON is to take the CAUSAL LINK we've come upon in the MOMENT and try to make sense of it and create a STORY and a NARRATIVE until we can't anymore --- the ANOMALIES have built up to such a degree that we know this STORY --- can't be "RIGHT."

The STORY the MENTAL HEALTH PROFESSION is telling themselves and others regarding PSYCHIATRIC DISORDERS is "NOT RIGHT" in FUNDAMENTAL WAYS that are preventing us from MORE EFFECTIVELY addressing the MENTAL HEALTH CRISIS that we see in most DEVELOPED COUNTRIES and DEVELOPING COUNTRIES.

Is the STORY "WRONG" --- well, it is MISSING KEY ELEMENTS that would DRAMATICALLY CHANGE TREATMENT STRATEGIES in MANY CASES.

On the other hand --- DON'T THROW THE BABY OUT WITH THE BATH WATER --- it is not as if there is nothing of value in our current approaches to treating "PSYCHIATRIC DISORDERS."

Further, many of our current approaches have SAVED LIVES --- even as those approaches are NOT SUFFICIENT to address the CRISIS we're currently facing.

WORK has to be a TWO-WAY STREET and it may be most easily seen in the "EXTREME" of people with NEURO-DEVELOPMENTAL DIFFERENCES and SERVICE PROVIDERS.

You can't just RAM Neuro-Diverse people into any old WORK Environment and think it is going to "work out"
- they often have BIG STRENGTHS that aren't getting SUFFICIENTLY CHALLENGED, and
- EXECUTIVE FUNCTIONING Differences or Deficits that are not receiving SUFFICIENT SUPPORT.

"My New Job Isn't What I Signed Up For" --- Inc.com

It has been HARD to understand how the Profession could:

Blow off the significance of a scientifically invalid DSM, and
Compelling Research of the last 5 to 10 years regarding the relationship between Neuro-Developmental & Psychiatric DIsorders BUT
This isn't necessarily APPEALING to the people who are currently in the Profession.

You can't just add FUNDAMENTAL ELEMENTS to the JOB Description of treating PSYCHIATRIC DISORDERS --- and think everyone who is currently working under the title MENTAL HEALTH PROVIDER --- wants to do or is even well-suited to incorporate those FUNDAMENTAL NEW ELEMENTS.

Are neurodevelopmental disorders discrete conditions? (2018)

There is abundant evidence to indicate that neurodevelopmental disorders tend to co-occur, rather than existing as individual conditions.

Could this ‘comorbidity’ reflect an overall atypical course of neural development, which manifests in various ways?

The NEW PARADIGMS from the RESEARCH view:

Neuro-Developmental Disorders as BLURRED
Psychiatric Disorders as BLURRED, and
Psychiatric Disorders as DISORDERS of the NEURO-DEVELOPMENTAL CONTINUUM

That's a far cry from the DSM and goes a long way to explaining why we are having such a hard time addressing our MENTAL HEALTH CRISIS ---

We've got a bigger problem than we realize, and
Our Systems are not set up to deal with it.
Further, a lot of people who went into Mental Health wanted to do "Mental Health Therapy" --- NOT work with people with DEVELOPMENTAL DISORDERS --- but that is their primary population
- THIS IS A PROBLEM.
- There is a role for therapy, but much of what is needed is DIFFERENT than what is being offered.
- Now, a lot of Mental Health Professionals if they had the TRAINING would be interested in working with people with DEVELOPMENTAL DISORDERS involving EXECUTIVE FUNCTIONING.
- Further, it is not as if Mental Health Professionals don't have some general knowledge, but by and large they are NOT the EXPERTS we need them to be, even if there are EXPERTS within their ranks, not surprisingly in EDUCATIONAL PSYCHOLOGY --- which is focused on more DEVELOPMENTAL ISSUES.

One of the points we've tried to make on this website is that CRIMINAL JUSTICE REFORM often FAILS because what's needed is so UNDER-ESTIMATED.

At least in part, that can be traced to Medical and Educational Under-Estimations of what it actually takes to address DIFFERENCES or DEFICITS in EXECUTIVE FUNCTIONING.

To say this is DISASTROUS sounds like hyperbole --- UNTIL you realize:

Most people with psychiatric disorders started out as people with neuro-developmental disorders involving EXECUTIVE FUNCTIONING, and
Graduated to people with psychiatric disorders and HYPER-CONNECTED BRAINS at least in part I would submit trying to manage those EXECUTIVE FUNCTIONING DIFFERENCES in a largely clueless if not PUNISHING SOCIAL ENVIRONMENT.

Those super sensitive / reactive people are becoming more sensitive and more reactive in attempts to address EXECUTIVE FUNCTIONING and that is DYSREGULATING SYSTEMS of the BODY even more.
Finding BALANCE and SUSTAINABILITY is a much more CHALLENGING PROPOSITION than we've been willing to recognize as a society ---- the more ASYNCHRONOUS the PERSON --- the more of a challenge that can be.

We somehow have this IDEA that DEVELOPMENTAL DIFFERENCE doesn't have any consequences if one has an AVERAGE or ABOVE-AVERAGE IQ.

Of course, our MENTAL HEALTH CRISIS and who it is affecting is telling quite a different story.
Further, that population of NEURO-DIVERSE people is steadily increasing as inflammation in the society and MATERNAL IMMUNE ACTIVATION increase.

It is not fair to say that the SOCIETY is causing ALL the CHALLENGES --- but it is FAIR to say the SOCIETY is EXACERBATING the CHALLENGES by FAILING TO ADEQUATELY APPRECIATE THEM.

Image Credit: VIA Institute on Character

Those NEURO-DIVERSE STRENGTHS that are a NATURAL ATTEMPT to BALANCE what may be MULTIPLE DYREGULATIONS of BODILY SYSTEMS by conventional standards --- may prove INSUFFICIENT ---

but those NEURO-DIVERSE STRENGTHS are still an IMPORTANT COMPONENT to MENTAL & PHYSICAL WELL BEING.

Maternal Immune Activation, DYSREGULATION INCLUDING Metabolic Dysregulation & the Tree of Knowledge

1/14/2022

Psychiatric Disorders appear to be in some to many cases a progression of Neuro-Developmental Disorders.

Further, those Neuro-Developmental disorders often bring with them DYSREGULATIONS of MULTIPLE SYSTEMS of the BODY.

Such DYSREGULATIONS "appear" to be IDIOSYNCRATIC and can tend toward one extreme or another.

Metabolic Dysregulations from Maternal Immune Activation are associated with Neuro-Developmental and Psychiatric Disorders.

This is above and beyond Professor Graham Rook's concerns of the lack of diversity in the HUMAN MICROBIOME that is causing the IMMUNE SYSTEM to be TOO SENSITIVE which might be considered a SOFTWARE CONCERN.

The issues with MATERNAL IMMUNE ACTIVATION --- appear to go to HARDWARE and perhaps more difficult to address.

Do these METABOLIC ABNORMALITES / DYSREGULATIONS represent another type of EXECUTIVE or UNCONSCIOUS FUNCTIONING that now has to be managed more CONSCIOUSLY with ADDITIONAL CHALLENGES?

Interestingly, "BIPOLAR DISORDER":

Bipolar Disorder is being conceptualized by the University of Michigan as a DEVELOPMENTAL DISORDER that includes
Cells that are MORE REACTIIVE
Further, Bipolar Disorder appears to involve DSYREGULATIONS of MULTIPLE SYSTEMS OF THE BODY
And those INTER-CONNECTED DYSREGULATIONS have a LIFE OF THEIR OWN

Tree of Knowledge --- The Art of DionJa'Y

Metabolic Disorders May Contribute to Anorexia
(2019)

Researchers say these metabolic abnormalities may not be symptoms of the eating disorder. They may be part of the cause.

Metabolic abnormalities associated with obesity in children and adolescents in Jordan (2011)

"Obesity was significantly associated with increased odds of individual metabolic abnormalities and their clustering."

Metabolic and behavioral features of acute hyperpurinergia and the maternal immune activation mouse model of autism spectrum disorder (2021)

Tree of Knowledge by Lucas Cranach the Elder

BUT all of those DYSREGULATIONS MAY FORCE a certain partaking of the TREE of KNOWLEDGE --- because you can't rely to the same EXTENT on AUTOMATIC FUNCTIONING.

So you MAY have to develop other skills including LOGIC SKILLS and other ABILILITIES much more than someone else -----

and what you're finding is what a lot of theologians and philosophers and artists found before you ---- YOU DON'T HAVE AN UNLIMITED ABILITY TO DO THAT.
The HYPER-CONNECTED BRAINS and DYSREGULATED SYSTEMS associated with NEURO-DEVELOPMENTAL and PSYCHIATRIC DISODERS are a kind of FORENSIC EVIDENCE that are telling a COMPLICATED TALE --- full of INTEGRATIVE COMPLEXITY.
- Just the kind of Tale that someone who was into the HUMANITIES would understand.

Addressing the failure of SYSTEMS to care for those with the greatest needs

1/4/2022

This person who is "GRAVELY DISABLED" has REFUSED MEDICATION & TALK THERAPY

there are no MENTAL HEALTH BEDS

WHATEVER SHALL WE DO?How does the person feel about:

Hotel Vouchers
Assisted Living
Nursing Homes
- Often Disfavored as Institutions
- Often a Step-Down from the Mental Health Institutions
- Nursing Homes COULD BE a great place to do DISCHARGE Planning for 30 to 90 days--
- BUT it is a TRAP if there is NOWHERE TO GO.

Medication

Is the person open to genetic testing as a way to get quicker and better insight into some Medication selections?
Medication is a complicated issue in Mental Health as it is in Cancer and other major illnesses.
Further, many people with High IQ Neuro-Developmental Differences involving Executive Functioning and/or Psychiatric Disorders:
- Have IDIOSYNCRATIC SYSTEMS --- and if they are on the Street or the Jail, etc. --- they may be OUTLIERS in an OUTLIER POPULATION.

For most people with PSYCHIATRIC DISORDERS it has been an ALICE IN WONDERLAND experience of YEARS of TRIAL & ERROR --- that maybe turned up something that "worked and was better than nothing" and maybe didn't.

Our Society needs the ability to deal with that COMPLEXITY both CONCEPTUALLY & PRACTICALLY.

Marshall Fire --- Photo Credit: AXIOS

The Researchers have been RINGING THE ALARM BELLS for the need for BETTER TREATMENTS for AWHILE --- and it is in their INTERESTS to do so.

In this year's PBS Program on Mental Health funded by the AMERICAN PSYCHIATRIC ASSOCIATION FOUNDATION --- that need for BETTER TREATMENTS was acknowledged.
BUT how many people in the SOCIETY understand the need for BETTER TREATMENTS as opposed to just the need to FORCE SOMETHING DOWN some RECALITRANT PATIENT'S THROAT?

MORE CONJECTURE --- EPIGENETICS

It seems that we should be talking about Neuro-Developmental Disorders such as ADHD and AUTISM with PSYCHIATRIC DISORDERS --- and a lot of the research does that.
What Neuro-Developmental and Psychiatric Disorders often have in common is EXECUTIVE FUNCTONING CHALLENGES.

MORE CONJECTURE: The Epigenetics of the IMMUNE SYSTEM are SENSITIVE because they need to be for our SURVIVAL.

BUT many factors are pushing our IMMUNE SYSTEMS TO THE LIMIT and we need better and more complete understandings of what's going on.
We've tended to fill in the gaps with PRO SOCIAL COMPETENCY RELIGION for people "we judge harshly"
- That "we judge harshly" comes from Stanford Neuro-Biologist Robert Sapolsky and his ADMONITION to be very careful in judging a behavior --- "ESPECIALLY IF IT IS A BEHAVIOR YOU JUDGE HARSHLY."

Doing Therapies

Music Therapy & Something like Britain's Key Changes which provides opportunities for patients to perform and record musical tracks.
Art Therapy
Animal Therapy (Dog, Equine)

Supported Employment

One of the insights of the Dartmouth Supported Employment Model was that if done in an INDIVIDUALIZED manner --- it could often improve Mental Health.
BUT Employment is tricky for people with Psychiatric Disorders or High IQ Neuro-Developmental Difference involving Executive Functioning
- People need to be challenged in their STRENGTHS (which can be HIGHER than EXPECTED), and
- SUPPORTED in areas of Executive Functioning such as Planning, Organization, Emotional Regulation and Short-Term Memory.

The truth is most people want HELP --- BUT the options are meager, especially when what we're doing is in some cases not working and hospital beds haven't gotten any cheaper.

SAMHSA.GOV

The National Registry of Evidence-Based Programs and Practices (NREPP) has been indefinitely suspended by federal health officials.

Since 1997, NREPP has listed effective, science-based interventions for behavioral health issues, including the prevention and treatment of mental illness and substance use disorders (SUD).

Programs included in NREPP were independently audited and regularly updated.

The registry included proven interventions as well as programs to avoid because they had not been shown to work sufficiently.

The White House froze the public database in September 2017 and months later pulled federal funding for NREPP, which was a project of The Substance Abuse and Mental Health Services Administration (SAMHSA).

This defunding of NREPP is more COMPLICATED than it looks --- mainly because CMS, SAMHSA and the STATES have largely failed to address the needs of people with the most serious mental health needs.

So when the conservative organizations like the Mental Illness Policy Organization and the Treatment Advocacy Center saw things like NREPP --- it made their BLOOD BOIL -- these governmental subdivisions had so FAILED at what should be their primary mission --- serving those with the greatest needs.

So we absolutely have to hold CMS, SAMHSA and the STATES' FEET TO THE FIRE on providing for those with the GREATEST NEEDS -- which isn't being done --- and it is INFURIATING.

On the other hand, this is a CONTINUUM and we do need the National Registry of Evidenced-Based Practices and Programs.]

The CATCH-22 for HIGH IQ DEVELOPMENTAL DIFFERENCE --- nobody is expecting or prepared to deal with the need for EXECUTIVE FUNCTIONING SUPPORT.

CONJECTURE: The FAILURE to address EXECUTIVE FUNCTIONING with REASONABLE ACCOMMODATIONS and WORKAROUNDS -- and even just some KNOWLEDGE -- is resulting in an EPIGENETIC CASCADE.

So the person's IMMUNE SYSTEM and SENSORY PROCESSING is RAMPING UP to find PATTERNS to address this CHALLENGE
BUT there are LIMITS which our SOCIETY and our MENTAL HEALTH Profession largely think NEURO-PLASTICITY or COGNITIVE BEHAVIORAL THERAPY ARE going to solve.
What's Happening --- you have a person with a NEURO-DEVELOPMENTAL DISORDER that now has a PSYCHIATRIC DISORDER and an even more HYPER-CONNECTED BRAIN.
- and a Mental Health Profession that is by and large CLUELESS those people with DEVELOPMENTAL DISABILITIES that they didn't want to treat are their PRIMARY POPULATION --- but with HIGHER IQs.

MANY JOB DESCRIPTIONS today read like "NO BLACKS, ASIANS, HISPANICS, LGBTQ NEED APPLY" for people who may have those EXECUTIVE FUNCTIONING CHALLENGES.

Because the knowledge doesn't appear to be there to deal with that on the part of anybody --- certainly the ADULT MENTAL HEALTH SYSTEM.
There are a HANDFUL of EDUCATIONAL PSYCHOLOGISTS and OCCUPATIONAL THERAPISTS who could add a lot to the discussion --- BUT we normally don't think of them for ADULTS.

If we can't discriminate against people because of their skin color or their sexual orientation or preference --

that ODDBALL in the corner who seems so EMOTIONAL or SPEAKING OUT of TURN, has BORING "SPECIAL INTERESTS," or is DISORGANIZED --- surely we can DISCRIMINATE AGAINST them --- that's OBJECTIVE CRITERIA, isn't it?

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