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Americans with Disabilities Act Inmate Patient Brain Injuries Introduction: The topic of this essay deals with managing IP cognitive impairments or distortions created by cumulative ADA brain injuries experienced with multiple sclerosis (MS). These defects in conjunction with associated stress hormone biochemical imbalance create emotional and mental health care disorders requiring medication intervention and treatment. IP provides detail firsthand insight in dealing with the intense suffering combination of several co-occurring physiological and psychological changes; this in addition to the required medication side effects and cognitive learning deficits, he is challenged with while currently programming in a California health care facility in Stockton, CA. Inmate Patient (IP) History: Programming IP is a 53 year old white male. 1st term 25 years to life for murder in San Diego County. IP has been in custody from May 1992 to present at the level of enhanced-out patient for medical and mental health care needs. Good program with no history of violence. 6' at 165 pounds. Ambulatory. Good physical condition. MS diagnosis Sept. 1998. Family history: Dad diagnosis schizophrenic paranoid; 1st cousin mom's side MS diagnosis; younger brother 30 died brain cancer; much more available. IP diagnosiis: ADA Brain Injuries- multiple sclerosis (MS) 13 documented brain lesions. Schizoaffective disorder (SAD) with mixed episodes mood mania and major depression. Over compulsive disorder (OCD). Post traumatic stress disorder (PTSD). Personality disorder. Emotional instability paranoia. Stress. Anxiety. Delusions. Hallucinations. Psychosis. Panic Attacks. Anhedonia. Attention deficit disorder (ADD). Lhermitte's Sign. Peyronies disease. Bladder and Bowel Problems. Constipation. Allergies. Rashes. Stress Fatigue. Vision disturbances. Balance. Gait. Vertigo. Dizziness. Coordination. Migraine headache. Cognitive impairments or distortions. Seizures. Restless leg syndrome. Extreme neck pain (esp. Rt. side). PAIN. Neuropathic pain. Dysesthesia. Parentheis. Bones, joints, muscles, muscle spasticity, cramps, tremors, stiff tightness, sore. ADA IP Brain Injuries MRI MS Lesions Location and Signs 2002 1) 1 cm lesion left centrum semiovale 2) 2nd small one nearby 3) 2 lesions located in immediate right periventricular white matter at the superolateral margin of the body of the right 4) lateral ventricle 5) 1 cm lesion within the subcortical white matter of the left parieto-occipital lobe at the level of the atria of the lateral ventricle 6) 2nd lesion located more posteromedial to the aforementioned one 7) lesion noted in the immediate periatrial white matter on the right 8) and of a lesion within the left side of the prons 9) 1 cm lesion is noted within the right frontal lobe adjacent to the right frontal horn 10) 1 cm lesion is also noted within the body of the corpus collosum 11) An additional lesion is also present within the right inferior frontal white matter 2006 Several in corpus collosum Several in subcortical white matter and centrum semiovale 2012 Several in centrum semivowel right frontal parietal lobe ventricular/subcortical white matter on left frontal and parietal temporal lobes 0.5 cm- 1.5cm Old left medial blow-out-type fracture (medial wall of left orbital) ADA IP Brain Injuries: Signs and Symptoms of IP From a scientific stand point, modern clinical psychiatry is still a very young, underdeveloped medical specialty because its target organ, the human brain, is not yet well understood. The human brains neural circuits, for example, are just beginning to be mapped by modern neuroscience in the Human Connections Project and Clarity. Validity problems with the diagnosis remain and await further work in the fields of psychiatric genetics, neuroimaging, and cognitive science that includes possible significant overlapping fields of cognitive, affective, and social neuroscience not yet conceptualized or defined in the field of psychiatric diagnosis, which may change the way schizoaffective disorder is conceptualized and defined in future versions of the DSM and ICD. The discipline of neuropsychology, by studying the relationship between behavior and brain function, bridges the gap between neural and cognitive science. Examples of this bridging role include studies in which cognitive models are used as conceptual frameworks to help explain the behavior of patients who have suffered damage to different parts of the brain. Thus, damage to the frontal lobes can conceptualized as a failure of the "central executive" component of working memory, and a failure of the "generate" function in another model of mental imagery would fit with some of the consequences of left parietal lobe damage. The analysis of changes in behavior and ability following damage to the brain is by far the oldest and probably the most informative method adopted for studying higher cortical functions. Usually these changes take the form of what is known as a deficit- that is, an impairment of the ability to act or think in some way. With certain stipulations, one can assume that the damaged part of the brain is involved in the function that has been lost. Reasonably certain conclusions about brain behavior relationships therefore, can be drawn only if similar well defined changes occur reliably in a substantial number of patients suffering from similar lesions or diseases states. The Frontal Lobe and Neurological Responses Brain Functions The forebrain serves to control cognition (the process of thinking, knowing, learning, and judging). Frontal lobes are particularly important for abstract thinking, for imagining the likely consequences of actions, and for understanding another person feelings or motives. They assist in producing emotions, languages, tasks, analyze, process and store information for thinking, speaking, and remembering. Injury to the frontal lobes can result in the loss of these abilities. Abnormalities in the brain injuries biochemical imbalance produce a more exceptional amount of stress hormones like prolonged secretion of norepinephrine and adrenalin and cortisol. There is the premise that prolonged stress hormones secretion induces brain and neurological damage which results in psychiatric disorders and physiological ailments. We will discuss three of the IP's diagnosis' for this case study: schizoaffective disorder with mixed episodes mood mania and major depression (SAD); multiple sclerosis (MS) with 13 brain injury lesions; post-traumatic stress disorder (PTSD). Major brain cell damages occur due to biochemical imbalance reactions. This in turn causes neurotransmitters to misfire. Brain circuits stop communication effectively, they "short circuit" each others information. In some instances this combination of brain activity and toxic protein biochemistry manifests in both psychological and physiological symptoms. In multiple sclerosis (MS) patients the elevated levels of SIPR2 proteins can allow immune cells in the brain attacking myelin, the protective sheath that causes axons, the brains messengers. People with over abundant D2 protein receptors in the prefrontal cortex have a predisposition to addictive behaviors like over-compulsive disorder (OCD), drug and alcohol addiction, or over eating. This combined with prolonged secretion of norepinephrine increases learned helplessness thus blocking recovery attempts. In theory the perception senses neuron impulses that are signaling synopses on a sensory pathway through the somatosensory area to the prefrontal cortex are overwhelmed by the abundant D2 protein sensor receptors causing the remaining perception sensors to be cancelled by biochemical reaction of the stress hormone norepinephrine. Reviewing the executive functions of the frontal lobes we learn the deficits seen after frontal lobe damage are described as "dysexecutive syndrome." Frontal lobe damage can affect people where they may have difficulty initiating a task or behavior. On the other hand, individuals with frontal lobe damage may perseverate being apparently unable to stop a behavior once it is started. Rather than appearing apathetic and hypoactive patients may be uninhibited and may appear rude. Such people may also have difficulty in planning and problem solving and may be incapable of creative thinking. A unifying theme in these disorders is the notion of inadequate control of organization of pieces of behavior that may in themselves be well formed. Patients with front lobe damage are easily distracted. Although their deficits may be superficially less dramatic than those associated with posterior lesions, they can have a drastic effect on everyday function. Irritability and personality change can also frequently seen after frontal lobe damage. Based on the evidence amassed by scholarly neuroscience, researchers in the last several decades, concrete evidence is offered from first hand accounts and recent scientific research of brain degeneration caused by prison stress. Prisoners are suffering not only mental anguish but also permanent physiological harm that will hinder their efforts to reintegrate into society. Many world renowned neuroscientists researchers have documented dramatic brain changes fundamentally altering the structures of the brain. This causes abnormalities of nerve cells in the cerebral cortex, which is "the most crucial area of the brain that makes us most human." In a recent news article appearing in AEON magazine, Dr. Shruti Ravindran of the American Association for the Advancement of Science (AAAS), discusses prisons tress in security housing units (SHU). He confirms the truth and reality that prison housing exacerbates PTSD, identity disorders, hypersensitivity to noise and touch insomnia, uncontrollable feelings of rage or fear, hallucinatory tendencies, paranoia, delirium, feelings of being introverted, bouts of depression, the function they begin to lose their very sense of self along with other experiences of solitary confinement destructive capabilities. Post-traumtic Stress Disorder (PTSD) IP Signs and Symptoms: PTSD is described as "the development of characteristic symptoms allowing exposure to an extreme traumatic stressor." A traumatic stressor must involve "actual or threatened death or serious injury or other threat to one's physical integrity." However, this event can be experienced directly, witnessed, or experienced vicariously. IP's commitment case factors verify type PTSD in conjunction with all his medical records. IP's re-exeperiencing symptoms include intrusive thoughts of the trauma, nightmare, flashbacks, and "trigger responses" (i.e. becoming distressed when a stimulus reminiscent of the trauma is encountered). IP avoidance/ numbing symptoms include avoiding situations reminiscent of the trauma, amnesia relating to the trauma, isolation from others, and a general feeling of emotional numbness. IP increased baseline physiological arousal symptoms include insomnia, angry outbursts or irritability, and a general sense of jumpiness. IP also notes he has had difficulty concentrating since the extreme traumatic stressor. IP suffered no symptoms prior to the trauma and notes his level of functioning drastically declined after the trauma. IP can link PTSD to criminal behavior in two primary ways. First, symptoms of PTSD led to criminal behavior. Second, the IP's commitment offense can be directly connected to the specific trauma that he experienced. Many symptoms of PTSD can lead to a lifestyle that is likely to result in criminal behavior and/or sudden outbursts of violence. Individuals with PTSD are often plagued by memories of the trauma and are chemically anxious. The emotional numbness many trauma survivors experience can lead the survivor to engage in sensation seeking behaviors in an attempt to experience some type of emotion. A survivor can misinterpret benign situations as threatening and cause them to respond with self protective behavior. Increased baseline physiological arousal results in violent behavior that is out of proportion to the perceived threat. It is common for trauma survivors to feel guilt, which can sometimes lead them to commit crimes that will likely result in their apprehension, punishment, serious injury, or death. One way that traumatic stressors can be linked to specific crimes in IP's case is that events immediately preceding the offense can realistically or symbolically force the individual to face unresolved conflicts related to the trauma. One of the most traumatic and stressful situations a person can experience is incarceration. The constant stress of dealing with hostile people, whether inmates or guards, will build up to a breaking point over the years. This can be manifested by a nervous breakdown or the development of a personality disorder. During incarceration, there are no breaks, no days off, and there is no time given to recuperate your sanity. Even if you go to solitary confinement, that is typically the loudest area in the prison. The problem is that there is very little effort to alleviate the stress that is the cause of so many psychological problems. Crimes that are directly linked to traumatic stressors usually have certain characteristics. Often the defendant (IP) has no criminal history and cannot offer a coherent explanation for the behavior. Others may also find it difficult to discern any current motivation for the crime. The choice of a victim may seem accidental, and an apparently benign situation may result in violence. There may be amnesia surrounding all or part of the crime, and the individual may report that there were numerous stressors prior to the crime that related literally on psychologically to the original trauma. The act itself may also be linked symbolically or realistically to the original trauma. However, the individual is usually unaware of this connection. Such is the exact case in point presented by this IP here and now. Although PTSD is a chronic condition, with the proper treatment and education, its symptoms can usually be successfully managed. It is unlikely that survivors receive the proper treatment for PTSD during incarceration. In fact, because prison life may re-traumatize a person, a lengthy incarceration will seriously exacerbate PTSD symptoms and cause the person's level of functioning to deteriorate. Schizoaffective Disorder (SAD) with Mixed Episodes of Mood (mild) Mania and Major Depression and Signs and Symptoms of IP Schizoaffective Disorder (SAD) is a mental disorder characterized by abnormal thought process and deregulated emotions. SAD has no exact known cause but is categorized as a brain disorder affecting the balance in neurotransmitter concentration of dopamine, glutamate, and serotonin systems. Extensive evidence exists showing abnormalities in the metabolism of tetrahjydrobiopterin (BH4), dopamine, and glutamate in people with schizophrenia, psychotic mood disorders, and schizoaffective disorder. People with schizoaffective disorder are likely to have co-occuring conditions, including anxiety disorder, and short term mild psychosis, mania. A psychosis may include delusions, hallucinations, disorganized speech, thinking, or behavior and negative symptoms. Delusions are false beliefs which are strongly held despite evidence to the contrary. hallucinations are disturbances in perception involving any of the five sense. A lack of responsiveness or negative symptoms include: alogia (lack of spontaneous speech), blunted affect (reduced intensity of outward emotional expression), avolition (loss of motivation), and anhedonia (inability to experience pleasure). Negative symptoms can be more lasting and more debilitating than positive symptoms of psychosis. Mood symptoms are of mania, hypomania, mixed episode or depression, and tend to be episodic rather than continuous. A mixed episode represents a combination of symptoms of mania and depression at the same time. Symptoms of mania include elevated or irritable mood, grandiosity (inflated self esteem), agitation, risk-taking behavior, decreased need to sleep, poor concentration, rapid speech, and racing thoughts. Symptoms of depression include low mood, apathy, changes in appetite or weight, disturbances in sleep, changes in motion activity, fatigue, guilty or worthlessness, and suicidal thinking. Sometimes people with SAD are likely to have co-occuring conditions, including anxiety disorders and substance abuse. Multipel Sclerosis (MS) IP Signs and Symptoms What is multiple sclerosis (MS)? MS is a disease of the central nervous system (CNS). The CNS consists of the brain and spinal cord. This disorders damages the protective insulation (known as "myelin") surrounding the nerves (known as "axons") and may also damage the nerves as well within the CNS. As a result, messages form the brain and spinal cord may short circuit, causing reduced on lost bodily function. The effects of MS differ with each individual. Some people experience symptoms for a short period to time and afterward may remain symptom free for years, while others may experience a more steady progression of the disease. Most researchers believe MS is an "autoimmune disease"-one in which white blood cells, meant to fight infection or disease, are misguided to target and attacked the body's own cells. This attack causes inflammation in the CNS, which may damage the myelin and ultimately injure the nerves. MS Signs and Symptoms of IP Areas of inflammation are known as "active lesions." Areas of thick scar tissues, known as "plaques," form alone the damaged myelin. The changes in size, number, and location of the lesions and plaques may determine the type and severity of symptoms. The term "multiple sclerosis" originates from the discovery of the plaques. Multiple refers to many, sclerosis refers to scars. Commonly seen symptoms include: fatigue, visual disorders, numbness, dizziness/vertigo, bladder and bowel dysfunction, weakness, tremor, impaired mobility, sexual dysfunction, slurred speech, spasticity (leg stiffness), swallowing disorder, chronic aching pain, depression, mild cognitive and memory difficulties. While MS has the potential to cause several different symptoms, the specific symptoms each person experiences vary greatly. MS may not be cured or prevented at this time. The good news is its not contagious. MS IP Cognitive Impairment Challenges and Learning Disabilities IP Signs and Symptoms Pandora's Box- IP Case Study interview note: The extensive interaction among all the IP's progressive MS brain injuries combined with his frequently episodic co-occuring physiological and psychological symptoms make his healthcare changes enormously complex. Add to this the IP's cognitive impairment dysfunction and medications side effects, it is truly a godsend miracle IP put this essay together at all. I'm embarrassed to confess how long it took in production. It is possible at this point that I am able to extemporaneously provide the examiner a preview of my records and insight to help you understand and learn from my circumstances. We always have to bare in mind repeated MS attacks of the central nervous system (CNS) is unpredictable and complicated in comprehending the severity of damages to the brain. Pinpointing all this evolutionary progression down to any science requires a lot of patience in research, isolate, catalog, categorizing, interpret, understand, manage, and time. IP is however up for the challenge, but that's another essay in the mix. Stay tuned in! Outside of "the box" thinking! MS IP Cognitive Impairment Challenges and Learning Disabilities IP Signs and Symptoms The executive functions of cognitive impairment disabilities I experience include: 1) trouble organizing and following through with complicated tasks 2) difficulty in setting priority, organizing time, and meeting deadlines 3) jumping from one task to another with no apparent logic 4) feeling bewildered and overwhelmed by a pending task and not knowing how or where to begin 5) word finding difficulties 6) difficulty following complex arguments or explanations 7) difficulty resuming a task a after an interruption 8)problems shifting back and forth between tasks Some significant memory changes that may intrude my everyday activities include: 1) difficulty learning and/or recalling new information 2) problems remembering the part of character in books 3) forgetting what was said in conversations, tv shows or movies 4) forgetting why you entered a room 5) losing or misplacing items, such as ID, glasses, or cup 6) forgetting peoples names, appointments, or phone numbers 7) forgetting to do a task you had planned. Some examples of my information processing that is not quick or efficient include: 1) productivity within a given period of time is reduced, even though the quality of the work is unchanged 2) it is difficult to respond quickly when a lot of information is involved 3) tasks that have a time element are more challenging (like court deadline dates) 4) processing information coming from several different sources at once becomes slower and more difficult 5) Planning and executing takes additional time to complete a task making it more difficult and stressful IP faces various attention and cognitive problems including: 1) difficulty screening out distractions, including noises, thoughts, competing activities 2) difficulty with "divided attention" such as listening to what a peer is saying at the same time that you are doing something else 3) running out of energy while reading or engaging in similar tasks that require intense concentration and focus (this can also involve fatigue) 4) an inability to stick to one task for any length of time without getting distracted 5) poor recall due to lack of attention when learning new information 6) difficulties with attention that decreases your ability to organize information in a way that will allow it to be recalled later 7) it is impossible to multitask ADA IP Brain Injuries Physiological Changes Listed Migraine headaches, seizures, balance, coordination, dizziness, slow motion skills, heat sensitive, chemical imbalance in central nervous system, pain, neurotic pain, dysesthesia, paresthesia, musculoskeletal pain discomfort in bones, joints, muscles, bladder and bowel problems, brain lesions, numbness and tingling sensations throughout all limbs, ulcer, anxiety, panic attacks, tremors, muscle stiffness, spasms, tightness, spasticity (especially in calve of legs), restless leg syndrome, tension, knots in neck muscle (especially right side very painful), cramps (especially pit of stomach), extreme sensitivity to noise- very distracting (like arguments, music, tv sound, dominos slamming on table, people yelling or calling to others, slurping their food when they eat or coughing, slamming doors, pounding on table, wall or toilet to make the beat noise while doing a rap music song), eyes sensitivity to bright light (sun light outside or coming through cell windows, highly lit areas, eye exam, day room night lights "on all night," flashlight in eyes while trying to sleep (by night watch guard) all throws off natural circadian rhythm), nose very sensitive to bad odors, allergies, rashes, stress, fatigue, sexual dysfunction, Peyronies disease, grind teeth, Lhermitte's sign, chronic aches pains that do not respond to treatment, shallow breathing, hyper vigilance, low white blood cell count (wounds take long time to heal), etc... ADA IP Brain Injuries Psychological Changes Listed. Irrational worries on how to conquer my worst fears, feelings of insecurity and inferiority, constantly struggle with loss, grief, loneliness, self-pity, shock, disbelief, betrayal, self-defeating thinking patterns, unrealistic worry, imaginative criticism where it does not exist, getting depressed by perceived criticism, having difficulties with others over frivolous matters, forgetting to see the big picture, notice changes in thinking skills (especially about how to survive my environment), memory (recall information and events accurately), my ability to set and achieve goals, plan and organize successfully, get started doing things, solve problems easily, notice changes in my mood (shifts abruptly), self-control of emotions (unusual inappropriate or involuntary laugh or cry), feeling of nervous and depressed, difficulty with secure housing conditions while incarcerated, personality disorder, anxiety, panic attacks, stress, distress, irritable, grouchy, short temper, PTSD, OCD, ADD, ADHD, MS, schizoaffective disorder (SAD), major depression (I'm always aware I feel depressed and just cannot understand my mindless misery or why it will not go away. I feel helpless to even pray it away. At one time I was higher functioning on Wellbutrin sustained release medication but the facility made it nonformulary due to IP abuse and high cost. It frustrated my recovery when you find what works best, why change it? I decompensate now. Doctors need to realize different medication(s) or medication works differently on some patients. What works for me best may not work for another due to our different brain chemistry. The point I'm making is this, because a few inmates abuse a particular drug, should it be banned? If an inmate abuses his cane and strikes someone, should they all be banned? The many should not have to suffer because of the few. Otherwise, we would all be even more depressed), disruptions to normal daily activities, hyper alert, easily distracted (causing frustration, paranoia, and confusion), mood mania, hypomania, psychosis, delusions, hallucinations, disorganized thoughts (racing, intrusive, repeating, distracting), increased suicide risk (emptiness, worthlessness, tearfulness, meaningless guilt without appropriate causes), relationship problems, withdraw and isolate from others due to paranoia, cognitive impairments and distortions (mainly in informational recall in memory and though control), easily distracted, can't concentrate or focus (especially on more than one thing even without any distractions), fear of telling others about my symptoms so I won't be their prey or leave myself vulnerable to prey to others manipulations of my circumstances or disabilities, condemned, vulnerable, weak, emasculated oftentimes, diminished ability to concentrate or make decisions due to lots of procrastination that make me feel even more guilt, constantly vicariously reliving commitment case and other traumas in the past over and over in my head (which causes me to re-experience those bad feelings all over again each time while searching for understanding and reasoning profess at that time), loss of interest in doing things that would normally interest you, then feelings of the loss and regret, difficulty feeling pleasure when things happen that would normally be pleasurable, feeling overwhelmed by bearing others bad situations and the heavy weight of the worlds problems on your shoulders, expecting the worst to happen much of the time (the advance planning obsession of convincing myself to pull through the imaginary or real fears and not to give up), constantly find myself role playing out potential real or imagined circumstantial scenarios and fears that most likely won't happen (this is a very major distraction going on in my head most all the time causing me to not be able to concentrate on whats at hand), feel misunderstood and sometimes rejected (mostly due to invisibility of my disabilities, I prefer to isolate from others so they will not see my symptoms and I won't offend them or myself), I feel plotted against, spied on, and hated by others (especially custody staff); I convince myself staff are racist, putting lies on me in my records to juice the Parole Board to extend my time for their job security and so that I won't even get out- thinking its all a conspiracy), uncertainty and confusion about what's happening to me and my future, I practice psychic numbing or have emotional anesthesia, PTSD symptoms, remission suppressed memory of past bad things I've experienced and new things I don't want to see (I catch myself saying I didn't really see what I just saw, don't worry about it, you're tripping, especially seeing sports (that bite you, like being poked hard with a needle, or seeing moving shadows out of the corner of your eyes, then learning their evil spirits trying to get into your body and make you do bad things, I try and get away from them and stay alert so they can't get me, not even in my sleep, that's why I always stay awake so much as possible), I have an unusual fear of changes, commitments or new challenges, I'm often passive or indecisive, impulsive in wrong decision making (when I end up regretting and then repeat due to forgetfulness), anhedonia (the inability to express or experience pleasure), self-talk of catastrophe survivor skills if disaster strikes, it is important and imperative I totally stay away from all potential high level of stress situations to overt relapse, trigger an exacerbation of psychosis, have trouble getting along with others at times, I have trouble completing projects and programs due to lost interest to just con't seem to get my mojo back, major sleep disorders and interrupted sleep (wake up real early), hyper alert because I totally believe folks are out to get me (even in my dreams). I seriously find myself consciously blocking pain out of my mind and body (both physical and mental pain) because it is annoying my concentration like a constant beggar of attention that just will not go away no matter what you do or say, it is a real quagmire to my mental health, so much more...I'll take a break until next time! IP Helpful Solutions for Managing Symptoms Read all information you can on your symptoms' management being practice in your health care. Keep a personal journal with set aside sections to monitor yourself awareness, like daily symptoms, all medical appointments, doctors note, important chronos and medications you're prescribed, sleep patterns, bladder problems, group therapy attendance schedule, intrusive thoughts, psychotic episodes, the dates when chronos or meds expire (for renewal info), addresses for community support and diagnosis outside organizations you correspond to for help, your cognitive restructuring plan that is goal oriented one step at a time, create your relapse prevention/maintenance plan, organized journal section for daily routine or schedule or combination thereof. Refer to your journal often in search of self awareness. Monitor your medications and dosage. Know what you are taking and any side effects. Research at library or ask clinical staff. Be mindful not to skip dosage as prescribed. Managing cognitive rehabilitation therapy involves figuring out the breakdowns in a person's thinking and creating strategies to help get around those problems. Counseling can be used to help a person understand and accept the changes they experience after a brain injury. This is sometimes done individually and sometimes in support groups. Ask your primary care clinician about supportive psychotherapy and cognitive behavioral therapy being available to you. You may have a intensive case management team assigned. Go over your high quality psychological or psychiatric rehabilitation program with them in detail. Sometimes you will receive both one on one psychotherapy and group therapy. Specialized social support group activity involvement offers a unique opportunity to interact with others who have similar or same symptoms, each sharing their challenges for better community understanding. They can offer each other for support on making big decisions. Have your therapist show you how to use therapy techniques like role playing, thought stopping, assertiveness, self talk, disempowerment and disconnection, systematic desensitization. It's about you making the right choices, getting enough sleep, avoiding alcohol, drugs, or violence, proper rest, exercise, sunlight, engaging in active anger or stress management, maintaining employment, education advancement, proper diet and hygiene, good rapport with staff on safe housing environment and stay away from people with drama. Being spiritually in tune does matter too! Conclusion IP has recently requested CDCR CHCF ADA cognitive remediation. IP requests to consult with DA disability accommodations staff and meet with a cognitive remediations specialist and neuropsychologist for diagnosis and assessment of cognitive problems by comprehensive evaluations. IP notes most all his symptoms randomly seem to migrate, rotate, alternate, appear and disappear. Always leaving the fearful mystery of what different challenge will he be faced with from any given time to the next. IP has made several cognitive disabilities ADA appeals to CDCR administration since 1996 requesting to be allowed to keep an all line laptop personal computer. Form CDCR 7410 Comprehensive Accommodation Chrono. IP needs his court case files scanned in his organized memory (9 legal boxes worth or more) in order to work on his court appeal using his own law library on CD ROM or DVD laptop memory flash drive too. A laptop pc would reasonably make this legal challenge for him manageable. He needs 24/7 access to all his case information on flash drive memory versus 8 boxes. IP wishes to acknowledge and give a blessed shout out to all the people in the same struggle. IP wants to thank all those who generously provided him with material and encouragement for this essay. Please see acknowledgements on back page. Thank you for all your consideration and continuing support. Respectfully submitted, D. Jester Acknowledgements American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders- SAD DSM-5 My Lord and Savior Jesus Christ National Center for PTSD National Alliance on Mental Illness NAMI National Multiple Sclerosis Society NMSS Multiple Sclerosis Association of America MSAA US Dep. of Education info on ADA, "The Teach Act," and The Rehabilitation Act Education Behind Bars Newsletter, Middle Street Publishing CDCR CHCF Health Care Administration and Custody and Law Library Encyclopedia Britannia Wikipedia Free Encyclopedia The Fortune Society Just Leadership USA San Quentin News and Law Office CA Prison Focus News Sacramento Bee News LA Times News FCLCA Community Alliance News Prison Legal News Barbara Brooks, SJRA Advocate Newsletter Solitary Watch California Lifers News Life Support Alliance Disability Rights Center CA United for a Responsible Budget Department of Veteran Affairs Coalition for Prisoners Rights Parole Matters, Charles Carbone, Esq. Friends Outside Armstrong v. Schwarzenegger, Court Ordered Remedial Plan (ARP 2001) Hecker v. CDCR Settlement ADA IP Rights (2014)
