Tuesday, March 27, 2012

Pandora's Box



There are so many ways to look at the March 20th Supreme Court case that asks whether it’s unconstitutional to sentence 14 year olds to life imprisonment after they have been convicted of murder.  Your viewpoint may be swayed by a lot of things.

Do you look at it from the viewpoint of the rights of those people older than 18 vs. those who are younger than 18?  [If I were a teenager, I’d argue that teenagers aren’t allowed to drink, smoke, vote, even serve in the army, but they can serve time in prison.  I’d have one question.  Are 14 year olds tried by a jury of their peers?  ]

Do you look at it from the viewpoint of the “haves” and “have nots,” where the “haves” are those people who avoid imprisonment because they can afford good legal representation and the “have nots” go to jail?  [As in the popular song “Rich People Don’t Go to Jail.  http://www.lyricsmania.com/rich_people_dont_go_to_jail_lyrics_anti-heros.html ]  

Or do you look at it from the viewpoint of black vs. white?  [See http://newsone.com/nation/casey-gane-mccalla/black-people-receive-60-longer-sentences-for-same-crimes/   “A new study by M. Marit Rehavi of the University of British Columbia and Sonja B. Starr of the University of Michigan Law School shows that Black Americans receive almost 60% longer prison sentences than white Americans who committed the same crime.”  If I were a Black American, that would bother me.]

{If you have not even heard of the Supreme Court case, check out: http://www.supremecourt.gov/oral_arguments/argument_audio_detail.aspx?argument=10-9646

For this blog I’d like to frame this issue in a way that appeals to my own personal, nerdy viewpoint.  I’d like to look at this court case strictly from the standpoint of brain development. 

I am of the opinion that the brain isn’t fully developed until you are in your early 20’s.  NPR recently ran a story about this.  (To see it go to:  http://www.npr.org/templates/story/story.php?storyId=141164708 )  In a nutshell it says that the brain of an 18 year old is only halfway through the process of maturing.  In particular, the “prefrontal cortex” isn’t fully developed until age 25.  And remember from Psychology class that the prefrontal cortex is where “Executive Functioning” occurs.  I won’t bore you with facts about Executive Functioning controlling such things as the ability to plan, organize, or inhibit impulses.  You know this already.

But, for a moment, think about this court case.  If the Supreme Court agrees that the brain of a teenager is not capable of sound judgment because their prefrontal cortex is different from the brain of a “normal” adult, could this affect other populations – both old and young?

I say “Yes!”

The following is a quote from Wikipedia’s “prefrontal cortex” page:
“In the last few decades, brain imaging systems have been used to determine brain region volumes and nerve linkages. Several studies have indicated that reduced volume and interconnections of the frontal lobes with other brain regions is observed in those with Attention Deficit Hyperactivity Disorder, schizophrenia, depression, and bipolar disorder; those subjected to repeated stressors;[26] suicide victims;[27] those incarcerated; criminals; sociopaths; those affected by lead poisoning;[28] and drug addicts. It is believed that at least some of the human abilities to feel guilt or remorse, and to interpret reality, lie in the prefrontal cortex.[29] It is also widely believed that the size and number (my emphasis) of connections in the prefrontal cortex relates directly to sentience, as the prefrontal cortex in humans occupies a far larger percentage of the brain than any other animal.”

I would even argue that Wikipedia left some stuff out of their article!  What about CVA?  What about TBI?  They both can affect the prefrontal cortex.

This is an exciting time, people.  What if, by ruling on this court case, the Supreme Court is, in essence, stating that a lot of the behaviors that society has in the past described as “weak,” “immoral,” “unethical,” “crazy” are not arrived at by choice?  What if those behaviors were PURELY a function of brain structure?

Wait a minute!  What are the implications of this ruling?  What about the limited number of psych visits that insurance will pay for?  You know the one where “mental” problems aren’t as important as “physical” problems.  What if the Supreme Court decides that, when it comes to the brain, “size does matter?” (pun intended)  Aren’t they opening Pandora’s box?

Maybe.  

May-be.

Juvenile love and protection not prison regression!




Well, I am really confused about exactly how our justice system works.   There are adults who can kill a child in cold blood (protected by a heavily flawed law) and walk free,  but a child who may be wrongfully convicted or involved in a killing (not necessarily the person who pulled the trigger)  is imprisoned for life.  This is crazy to me and I just can’t wrap my head around it.

The Chicago Tribune stated that “advances in our understanding of brain development show that juveniles have little impulse control or the capability to fully consider or appreciate the lifetime of consequences some of their actions hold”. At the same time, experts say juveniles have a” greater capacity for rehabilitation, particularly if they are given the right treatment.”  Let’s be frank here.  Some of the situations such as that of Adolfo Davis where children are growing up without guidance or adequate love and protection would rarely lead to an  individual that was successful or a model citizen.  As a society we should try to eliminate the environment and lifestyle that can lead to the juveniles crimes and eventually imprisonment of juveniles,  rather than waiting and allowing bars and a cell to solve the issue. 

Unfortunately to say there is a racial and socioeconomic component to this issue.   There is a new report published by the Sentencing Project that also shows the comparison of African American juvenile lifers to Caucasian juvenile lifers. According to the article “Black Youth Disproportionately Sentenced to Life Without Parole” the racial dynamics of victims and offenders may  determine  which offenders are sentenced to juvenile life without parole. “The proportion of African Americans serving JLWOP sentences for the killing of a white person (43.4%) is nearly twice the rate at which African American juveniles are arrested for taking a white person’s life (23.2%); Conversely, white juvenile offenders with black victims are only about half as likely (3.6%) to receive a JLWOP sentence as their proportion of arrests for killing blacks (6.4%).   

I understand that laws should be adhered to, but in certain cases such as Adolfo Davis’ and TrayVon Martin’s, laws are twisted to benefit those who are in the wrong and punish those who should be granted the opportunity to remediate themselves.  Please do not misinterpret what I am trying to say.  There are crimes that minors can commit that are especially heinous or well thought out, therefore should be punished accordingly.   However, the juveniles  who after years of remediation can be entered back into society and their families, and live fruitful lives, should be allowed to do so.

THINK PAST THE CRIME

“THINK PAST THE CRIME”
To speak about a subject like this is very difficult because you don’t want to offend the victim’s family by giving off a “just forgive and get over it” attitude, but at the same time you want to believe that a second chance should be given to all of these juveniles.

I feel as though a person’s background, environment, and mental stability have a great impact on actions.  Giving these children life but yet supplying them with education, degrees, communication skills, etiquette, and job interview skills is pointless when they will never have a chance of knowing what freedom feels like anymore.  When you think about one of the most degrading things you can do to a human being is like them away.  It is our human nature to adapt.  We throw these children in a prison for life already damaged from their previous environment with no therapy.  Where do they find the guidance and control to actually learn and grow from their mistakes?  Their off the streets where all they seen was violence and separation and going into a building with bars and rules with nothing but violence and separation. Raphael Johnson, a former juvenile states “The system is designed to really destroy. It is not designed for rehabilitation, it's not designed for self correction, self analysis.”  This is an article so that one can see the juveniles position.  By no means am I saying their actions are justified, just thinking how much wrong we have done in our secret closets and how society would condemn us if it was known.  Maybe not to the extreme of prison… but just dealing with your own inner demons are enough for a day.

http://www.npr.org/2012/03/20/148919350/without-parole-juveniles-face-bleak-life-in-prison


Sunday, March 25, 2012

Young Minds and Crime

When the supreme court decides on whether or not to sentence juvenile offenders to life without parole, what will they be thinking of? The families of victims gone but never forgotten? The idea that living in our society affords the  basic decencies of respect, honor, and justice for all? Upholding the constitution?
I suppose any number of questions and answers will be racing through the minds of those who are to decide these youngsters' fates. But whatever happened to the concept of rehabilitation? I realize of course that we have to keep the community safe and in so doing, certain rules should be followed. When they are not, offenders must be held accountable. But how do we do this with juvenile offenders and yet still find a way to bring positive influences to their important but gradual development? Steve Mills of the Chicago Tribune reports that, "...experts say juveniles have a greater capacity for rehabilitation, particularly if they are given the right treatment".
If we are holding back from helping young offenders because we think they are not our responsibility we'd better think again. Our prison system has become an overcrowded holding cell of avoidance, resentments and pain. Each of us may not be cut out to be a child's mentor, to be of service to those living on the edge of our world, but as a society we must be better than the individual.
This is not to discount the many family members who must live everyday without their loved ones. They suffer senselessly and must navigate that road through fear and unimaginable grief. There are support groups and counselors within our system whose sole aim is to go through this experience with them. They are provided with as much help as we can give them, which is some cases may not count for much. But do we not believe that young offenders should be supported and guided as well?
Consider this--"Hard science demonstrates that teenagers and young adults are not fully mature in their judgment, problem solving and decision-making capacities," (http://act4jj.org/media/factsheets/factsheet_12.pdf). There is a lot about the brain we do not know but something we do know is that the part of the brain that serves to run our impulse control, advanced thought, and reasoning skills is the very last area to mature. How can we not consider this when developing sentences for offenders who aren't operating with all of their capacities? I understand that we are all entitled to our beliefs and opinions AND I recognize that I cannot relate to someone who has lost a loved one to the hands of an immature murderer. Dealing with this is beyond me. I do, however, believe that as fellow human beings we owe it to ourselves to help each other out, to guide those of us who have no tools for living, and to treat each other with love and tolerance. We owe it to ourselves as a society so that we can change and evolve and somehow survive this technological adolescence we find ourselves in. The fact that this is a debatable topic is almost shameful. How will we ever not only survive but flourish if we cannot support those who more than likely came into this world with the cards stacked against them? A child that commits a heinous crime such as murder obviously needs proper treatment and attention; they don't need to be locked away and conveniently forgotten by society at large, or by the healthcare system. We're only harming our world by avoiding the problem instead of looking for the solution.

Life without Parole?


Should juveniles be sentenced to life without parole when they commit murder? This is the question at hand. To me, there is too much grey area for a yes or no answer to this question. There are too many factors that influence my decision. I DO feel that people should be punished for their crimes. I DO feel that victims’ families should be able to have closure and some sort of peace in their lives about their loved ones being murdered. But, on the other hand, I also feel that people can be rehabilitated, especially juveniles. Juveniles are influenced by their environment and by the people that they surround themselves with. When I was a juvenile, if one of my friends jumped off of the bridge into the lake, guess what, I was going to do the same thing. That’s just the way it is. So, for example, if someone grows up poor, get teased because of their clothing, and is lacking a family life, then they find their own family, which in Adolfo Davis' case happened to be a gang. He likely got caught up doing as any other juvenile would do...being influenced by the people that he surrounds himself with. But in his case there were 2 people murdered and he was tried as an adult and sentenced to life without parole. But he was only 14 years old, and he was tried as an adult…but did he have the same sense of “right and wrong” that an adult would have? Maybe, maybe not. Did he have a mental illness?

According to Sarah Hammond, “Many of the two million children and adolescents arrested each year in the United States have a mental health disorder. As many as 70 percent of youth in the system are affected with a mental disorder, and one in five suffer from a mental illness so severe as to impair their ability to function as a young person and grow into a responsible adult”(Hammond, 2007). If Adolfo Davis’ had a mental illness that was addressed in his childhood maybe his part in the crime would have never happened. As stated above, there are many juveniles in the prison systems that have a mental illness that are not getting the treatment that they need. For further information, click here

In conclusion, for me it has to be on a case by case basis. I would be happy for Adolfo Davis’ if he got a second chance but I would be sad for the victims’ families who were told that he was sentenced to life without the possibility of parole. Now, they would have to deal with the fact that a person who was involved in the murder of their family member was a free man.

Saturday, March 24, 2012

Juveniles Behind Bars: Life Without Opportunity

Some subjects have always inspired heated debate throughout the world, and always will. One of those subjects is how does a society deal with those people who violate the laws imposed upon its people. On Tuesday the Supreme Court started hearing arguments about how the US sentences juvenile offenders, in particular those involved with murder cases. You can click here for the specific cases that the Supreme Court will be basing their decisions upon. 

From a personal perspective I remain on the fence about how we treat these people; each and every case must be judged based on the unique circumstances of the crime. Some would say that if you commit premeditated murder then you no longer deserve a place in society, but what if you had the misfortune of suffering daily abuse by a family member and feared for your life? What if you get into a fight after being bullied, pull a prank on a friend that takes an unexpected turn, or you happen to be in the wrong place at the wrong time? These are situations faced by teenagers all over the US and the world. They are forced into adult situations at a time when their hormones are raging, the don't have the life experiences to develop adequate problem solving skills, and they don't fully understand the depth of the choices they make. One bad decision could mean LIFE in prison.

In my opinion, I believe that everyone can positively contribute to society in some way, so if we sentence a juvenile to a life in prison we destroy the ability for that person to live up to their full potential. So the next time you're reading the newspaper or watching the news and you hear about a juvenile facing prison time, ask yourself, "What could this person do with a second chance?"


Monday, March 12, 2012

Open your mind!




You may see someone pacing back and forth talking to themselves and you may think to yourself ‘oh they’re not all there’ or you see someone who is clearly strung out on drugs  and may think to yourself ‘why would they allow themselves to get that bad’.   The thing is, it’s not that cut and dry and mental illness is not to be taken lightly. You see, mental illness has no face to it.  It can affect anyone, and not only the individual suffering from it but everyone in their support system.   According to NAMI mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning.  This can be caused by a chemical imbalance or may be triggered by a situational occurrence. 

I had the wonderful opportunity to have two guest speakers from NAMI’s “In Our Own Voice” program speak to my class this week.  It was very interesting to hear the two very different personal stories of our guest speakers.   One of the speaker’s mental illnesses can be contributed to a chemical imbalance but was exacerbated by the death of his entire immediate family while the other’s mental illness can be contributed to a situational occurrence.   Although their mental illness diagnoses were different they both attributed their success with leadng productive and meaningful lives to their coping strategies and their support system.   

According to the National Consensus Statement on Mental Health Recovery, mental recovery is defined as “a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to reach his or her potential.”  This goes hand in hand with the philosophy of occupational therapy and as OT practitioners we can use our therapeutic use of self to develop the skills of our clients and encourage clients to engage in activities that are interesting and meaningful to them.  But most importantly we can educate and encourage our clients to meet their personal goals for recovery.


Here is the pdf for the National Consensus Statement on Mental Health Recovery.
http://www.mentalhealth.samhsa.gov/media/ken/pdf/SMA05-4129/trifold.pdf

Sunday, March 11, 2012

PART OF THE HELP? OR PART OF THE PROBLEM

I sat in the class on 3/5/2012 and listened to the speakers of NAMI and realized how the support from others can impact these individual’s lives. Listening to their stories made me open my eyes and face that mental illness has no respect of person; anyone can be a victim. The speakers began to breakdown the pathway of the struggle they face on a daily basis saying “This is a daily struggle…. it doesn’t stop”.  They broke down their illness using 5 phases

1.       Dark Days- phase in which they told what type of life they had before the illness and symptoms they began to have before they were diagnosed.

2.       Acceptance- phase in which the individual has to come to terms with the illness and be able to face it and deal with it. Hardest stage.

3.       Treatment- phase in which they seek help whether its support groups, therapy, or medication

4.       Coping Skills- phase in which they explained how they continue to deal with their illnesses.

5.       Successes, Hopes, and Dreams- phase in which you see how far they have come.

Hearing this presentation made me very grateful for who I am.  I was a young child when I saw my great-grandmother suffer from schizophrenia, both of my uncle’s heroine and alcoholic addicts, but I never seen it as an illness.  I just remember being very afraid, and as I grew older I recall just being angry because I felt like they had a choice and could have gone in a different direction.  As I look back I realize their actions were their way of asking for help.  I walked out the classroom asking myself “How could their recovery be different if I could have been a support system rather than being afraid, embarrassed, and judgmental just like most of society?”

I look at my older sister who has just been diagnosed with Bi-polar disorder about a year ago; and I realized just how much she needs me now.  I understand now the support from love ones and peers that will just lend an ear is very comforting and encouraging to those with mental illness.  Although we can never feel what these individuals feel we can attempt to help them cope with the illness and face it more and more on a daily basis.  As an OTA I am responsible for helping individuals become more independent. Being independent to me is helping these individuals to be able to carry on a fulfilling, successful, and happy life.  Understanding that whatever “side-effects” comes with the illness they can handle. I understand now that these individuals are just like me and it could be me; and because of this I can handle having a career with individuals with mental illness.  So you now you choose DO YOU WANT TO BE PART OF THE HELP? OR PART OF THE PROBLEM?

Here is a website that has a few testimonials that allows you see how normal these individual were and how it could happen to anyone.






Where do you think they'll end up? If you answered jail, you're right!!





Two guys from NAMI came to talk to our OTA class about their on-going journey on the road back from mental illness.  They were representatives from NAMI’s In Our Own Voice, IOOV, program whose job it is to put a human face on mental illness.   These guys didn’t look mentally ill to me.  They were good looking, clean-cut, well-spoken, nicely dressed gentlemen.  

They started talking about their experiences with mental illness.  At first they didn’t seem to have a lot in common.  One guy was born with a “self-professed” silver spoon in his mouth and had been afforded almost every advantage imaginable.  Most people would give their eye teeth to have a life like his.  The other guy was a country boy from a blue-collar family who hadn’t been given much as a child but who had fought for our country and had earned the respect of his family and fellow servicemen.

The upper class guy did fairly well until he went to college when academic pressures kicked off a bipolar roller coaster.  Then a series of life-altering family tragedies dealt him a one-two punch that changed his life forever.  As a result, he self-medicated to deal with the pain and was later diagnosed with PTSD.

The working class guy worked hard and excelled in the military environment.  He, too, seemed successful, but, as is common with many veterans, during the course of his duties he witnessed some things “that no one should see.”  As a result, he, too, developed PTSD.

These revelations on the surface might seem like the reason these two guys teamed up together to make their presentation to our OTA class, and that’s fine.  Still I was a bit puzzled why these guys referred to themselves as “brothers.”   That’s when they made their real disclosure.

As their stories unfolded, I learned that the upper class guy had developed substance abuse issues and was subsequently incarcerated for five years!  And based on the stories he had to tell, to say that he was inhumanely treated would be an understatement.

On the other hand, the working class guy coped rather well with his mental illness after the war.  However, one day a medication-induced psychosis landed him in jail, not a hospital, mind you, but jail!  Suddenly, these two good-looking, well-spoken gentlemen were in places that were designed for society’s outcasts.  And if it could happen to them, it could happen to anyone!

Jail is a scary place where we send people who need to be punished.  It’s a place where people’s rights are minimal and management sometimes turns a blind eye to the violations of these rights.  But that’s okay, right?  I mean after all jail is a place for criminals.  It shouldn’t be a country club. 

At the heart of the IOOV presentation, the thing that blew me away was that jail is not only the place that criminals go.  It also happens to be the place where we send our mentally ill.  We take some of the most at-risk members of our society, and we confine them with people who have already been found guilty of ignoring the law.  Does that seem right?

Therein, I learned the real reason that these two guys had teamed up and were going from one speaking engagement to another.  PTSD is bad.  Mental illness is bad.  But when you incarcerate a person for being mentally ill, that’s really bad.  Society needs to take note when the rights of the mentally ill are violated because they don’t have all the mental “tools” with which to protect themselves.

To illustrate this problem, here are some statistics from the NAMI website: 
  • “In 1998, 283,800 people with mental illnesses were incarcerated in American prisons and jails. This is four times the number of people in state mental hospitals throughout the country. xiv
  • Sixteen percent (179,200) of state prison inmates, seven percent (7,900) of federal inmates, 16 percent (96,700) of people in local jails, and 16 percent (547,800) of probationers have reported a mental illness. xv
  • §  Mentally ill offenders are more likely than other offenders to have a history of substance abuse/dependency and a higher rate of homelessness and unemployment prior to incarceration.”

The speakers talked about the stigma that a mental illness diagnosis can confer.  I wonder what will I,  as an OTA, do to stop this discrimination?  How will I advocate for the mentally ill?

I hope in my practice that I do not judge my mentally ill clients.  I hope I give them the same respect that I give to everyone else.  I hope that when I meet someone who has been in jail, that I consider the above statistics and realize that they could be mentally ill and not just a “common criminal.”

--------------------------------------------------------------------------------------------------------------------

For more information about mental illness, incarceration, and stigma see the following:

“The Criminalization of Mental Illness:  Crisis and Opportunity for the Justice System” by Risdon N. Slate, W. Wesley Johnson, 2008 $45.00 432 pp paper ISBN: 978-1-59460-268-9 LCCN 2008008281








The SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health (ADS Center)


NAMI’s policy on the criminalization of people with mental illness: 
 
 
Human Rights Watch article on US prisons and people with mental illness: 


To do something about the treatment of the mentally ill see the Treatment Advocacy Center’s website:
http://www.treatmentadvocacycenter.org/solution/getting-involved







POP the Stigma on Mental Illness


During a visit to the mental asylum, a visitor asked the Director what the criterion was which defined whether or not a patient should be institutionalized.
"Well," said the Director, "we fill up a bathtub, then we offer a teaspoon, a teacup and a bucket to the patient and ask him or her to empty the bathtub."
"Oh, I understand," said the visitor. "A normal person would use the bucket because it's bigger than the spoon or the teacup.
"No." said the Director, "A normal person would pull the plug. Do you want a bed near the window?

Erdman, B. (n.d.). Mental health humor!. Retrieved from http://www.bouldertherapist.com/html/humor/MentalHealthHumor/bathtubtest.html

image taken from: http://www.logomagnet.com/administer/images/POP-THE-STIGMA-BALLON.jpg



Stigma Busting. Wow I learned a lot today! These speakers were excellent and very knowledgeable. It was nice and refreshing to have speakers that have actually experienced what we have been learning about in class. The point from the “joke” above is that mental illness can affect anyone, from a war veteran to an upper class college athlete. It doesn’t have to be the “pan handler” on the side of the highway, it can be anyone. Mental illness is not a joke. There are so many people in the world that can’t and don’t understand what they are going through. I had an old friend of mine that battled addiction and mental illness who eventually couldn’t take the pain anymore and ended up taking his own life. Wow. Could the pain be that bad? To the point where nothing else matters and killing yourself is the answer? Well, unfortunately to some people the answer to this is yes…which is why mental illness awareness is so important! I want the world to know about, and be aware of mental illness. With that being said, I, as a future OTA, will help to reduce the stigma that surrounds mental illness and spread the knowledge that I've learned onto others!