The Sights in DC

I spent a week in DC for the ACI conference organized by ASAN. The conference schedule was pretty hectic, so there was barely any time to see the sights in DC. I had never been to DC so wanted to see at least a couple of the historic landmarks. 

National Mall

The conference on Sunday was starting only at 2pm, so we used that opportunity to go see the National Mall that morning. It was a blistering hot day. Had not expected the weather in DC to be this hot - in the 80s and 90s. Apparently, DC is both cold in winter and equally hot in summer. Showers were also expected that day so we had to take rain jackets as well which was a bit of a drag. Luckily it did not rain when we were walking around. We did not have a lot of time so had to rush to see a few things and could not linger at any. 

The über dropped us off in front of Lincoln Memorial. Wow - Lincoln Memorial is more impressive live than on TV. What can I say? 

Lincoln Memorial

The 36 columns in the Parthenon-like Lincoln Memorial building are the 36 initial states. The 19 ft tall marble Lincoln sits in deep contemplation, perhaps pondering the state of our country then and now. On the walls is his second inauguration speech.

Abe Lincoln

Marble Lincoln 19 feet tall

Glory days etched on towering column and wall

Bothered not by milling crowds

Determination, Compassion

Bent in contemplative reflection

Witness of democracy

mirrored in the reflecting pool

Things of past, sights of present
and protests in between

I wonder....

What would you say Abe?

If you were now given a voice?

If you were given a voice?
What would you now say, Abe?

We walked on the trail around the Tidal Basin all the way to Jefferson Memorial. Along the trail are many of the monuments like the Korean War Memorial, MLK Memorial, Roosevelt Memorial, etc. What a grand and wonderful tribute to the ideals of democracy and our history.  

We could stop only at a handful of them as we had to get back. Washington Monument was closed for repairs unfortunately so could not get an aerial view of DC. Next time.

MLK Memorial

Washington Monument

Jefferson Memorial

Korean War Memorial

"Freedom is not Free"
- Korean War Memorial

"Out of a Mountain of Despair, A Stone of Hope"
- MLK Memorial

"Among American citizens, the should be no forgotten men and no forgotten race"
- FDR memorial

"The test of progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have too little. "- FDR Memorial

Lovely sentiments
Powerful messages
Set in stone, eons ago.

But what do we do?
We read, we admire... the words, the history.
We think we contemplate the meaning and grandeur of it all
We think we understand.
We really think we understand.
We really really think we understand.
We think we come away better folks.
Oh yes, we are now better folks.

But PRACTICE..... Oh No, that we do not. 
That we do not. 
Oh No, that we do not.  

Glanced at words, easily forgot.
Post on social media, then forgot
It's back to 'real' life, says we


The White House
A second sightseeing jaunt happened after our Hill Day visit on Friday, Jun 21 evening. Can't leave DC without a peek at the White House. 

Two of my ACI friends Lia and Rebecca accompanied us.  I'm so glad they both came along as they really enlivened the outing with their lively chatter and comments. 

Though The White House is just a little more than a mile away from Capitol Hill, it took forever for the Uber Driver to get to us on the steps of the US House of Representatives Building and then take up there as the traffic is pretty congested in DC. 

The White House

Opposite The White House was a man camped out under an umbrella surrounded by protest posters. Deja Vu! It so reminded me of all the protest posters that line Sproul Plaza on the UC Berkeley campus. 

Poster reads "Wanted: Wisdom and Honesty"
- opposite The White House

I even met another Cal (UC Berkeley) student there. She came up and asked if I was going to Cal and nostalgically remarked that she's just graduated. And added, "Go Bears!!"

On the way to the White House, there was a quick photo stop in front of the Treasury Building. 

US Treasury

It was a super hot day and my suit jacket just got soaked with sweat. So off came the tie and jacket but could do nothing about my long sleeve shirt. 

The Smithsonian
We were also hoping to catch a Smithsonian Museum if one was still open. Turns out the Smithsonian American Art Museum was still open. 

Smithsonian Museum of American Art

Feb 22 - I share a birthday with George Washington

Nice attempt at accessibility features in each gallery. 

Except the Spanish large print book had the English version inside and vice versa. 

A braille version too. My train of thought immediately went to what I'd read in Georgina Kleege's book, "More than meets the Eye: What Blindness brings to Art," and the interview I'd done with her for the A&E at the Daily Cal. 

I wondered what the braille print book said - did it give a sensory description of each image or did it just verbatim copy the explanations on the wall by each picture - meant for visual people. 

I'm a tactile person too in many ways, I was hard-pressed to not touch impulsively touch the images.  

My class with Prof. Victor Pineda last semester also really made me think of accessibility in a whole new way. 

Accessibility at the Museum

The president who happened to sign the ADA

What a lovely visual - showing the "emergence" of the Special Olympics

The story behind the Special Olympics is not so pretty. JFK and Eunice Kennedy Shriver's sister Rosemary was dx with ID and made to undergo a lobotomy by her father at age 23, supposedly to help with mood swings and her interest in the opposite sex. The lobotomy was a failure and reduced her to the level of a 2 year old with no speech for the rest of her life. None of her siblings knew of the lobotomy for nearly 2 decades as she was kept secluded. 

Pictures of earlier presidents in the Presidential Gallery were very formal and "portrait like"

JFK was a nice change - kinda nifty abstract arty. 

Picture taken for the beautiful "Capitol Hill" building that we spent all day in

A fitting message for us advocates from Barbara Jordan

"If you are dissatisfied with the way things are, 

then you have got to resolve to change them" 

Hill Day Visit

The culmination of the weeklong ACI leadership training is a visit to Capitol Hill to meet with congressional staffers. 

All dressed up and ready for "Autistic Prom" - inside joke.

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Stop 1 of 3 in making a case to our congressional staffers.

Senator Kamala Harris's office in the US Senate.

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Pinning our CA location inside Senator Harris' office

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Meeting 2 of 3 at Senator Diane Feinstein's office in the US Senate. 

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Meeting 3 of 3 in the afternoon at Representative Barbara Lee's office in the US House of Representatives Building.

Rep Lee is a Cal Alum. Go Bears!!

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Got to ride on the "Secret Train," underneath the US Senate Building.

Too Cool 😍😍😍😍😍😍😍😍😍😍 to ride on a secret train. Icing on cake during Hill visit.

A congressional staffer has to agree to take you and has to accompany you. The Feinstein staffer got a Cal (UC Berkeley) intern to escort Ari and me on the train (Go Bears!!).

There is a separate security check to go on the secret train and you are issued a new badge. No food of any kind allowed on the train - so out went my chips as well as the water.

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The secret train only takes you from the Senate Building to the Hill. You still have to walk the rest of the day from the Hill to the House Building through a long underground tunnel featuring lots of artwork on the side. 

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Now have to plan and type the follow-up emails post-meetings.

Thu Jun 20 - Hill Day Prep

Part of the ACI Leadership Academy Training was the prep for our “Hill Day” on Friday where we get to meet our Congressional staffers at Capitol Hill to discuss several disability policies with them. Specifically we discussed three policies in Thursday's sessions.

TCEA - Transition to Competitive Employment Act. In a nutshell there are two issues here - segregated sheltered workshops and payment of minimum wage. TCEA would essentially close the sheltered workshops which pay disabled people a sub minimum wage for so-called “work” which basically amounts to adult daycare. This bill would provide states and companies the time and money they’d need to phase out these workshops and create substantial, gainful employment for citizens with disabilities in mainstream society. 

KASSA - Keep All Children Safe Act. Unfortunately, the fact of the matter is that students of color or students with disabilities, are more likely to be restrained or secluded in schools. For example,  In December of 2018, 13 year old Max Benson of El Dorado Hills, CA,  died after being physically held face down for an hour. It can be hard to breathe when being held down. KASSA would ban the use of mechanical, chemical and physical restraints that make it hard to breathe as well as  seclusion. Kassa would limit the use of physical restraints to situations where there is imminent risk to safety.. There are other ways of working with challenging behaviors. With adequate training, a vast majority of seclusion and restraint can be prevented. The school must inform the parents and the states would have to provide congress data on how many students are restrained. Right now the OCR watchdog has found that states underreport, some states even reporting zero restraints.   

JRC - At the Judge Rotenberg Center in Massachusetts, electric skin shocks are still routinely used on disabled individuals for even trivial non compliance things like getting out of the chair or not taking off their coat. The shocks are administered remotely via a battery powered device that individuals are forced to wear.  Putting it plainly, American citizens are still being tortured in 2019 just because they are disabled. We would not accept this kind of so-called treatment for able-bodied and neurotypical individuals, and so we shouldn’t tolerate it for disabled people. 

After the policies were discussed in Thursday’s sessions, we all sat late discussing how we would present our case at each of our meetings at the offices of the 2 senators and that of our respective local representative. Ari was from Mills college in Oakland so we would have the same three meetings in common. Shanna was from UC Santa Barbara, so would be there for the senate meetings then go to meet her own rep. Being nonspeaking meant I have to plan ahead as to what exactly I would have to say and coordinate with the others as to what would be spoken by them and what would be through the text to speech on my computer. That idea always takes a little while for speakers to get but it works out and we figured out how to divvy it up.

Creative Consultant for a Play on Autism

"Helping Hands" is an Australian play on the idea of "help" when it comes to autism. It highlights the irony that sometimes "well-intentional" does not always translate into "help."

I'm a creative consultant for the play as there is a non-speaking character. 
Had a lot of fun with this project. 
https://drive.google.com/file/d/1qWouzRAUVg81vQjZmCvBZgWkJMFk250q/view?usp=sharing

https://www.pozible.com/project/helping-hands

Trailer. https://vimeo.com/341543299


In the next video, co-director Hannah Aroni talks about some principles in social work that influenced this play. A quick recap
1. Reflective Practice - be aware that you bring your own implicit biases when you try to "help" those with autism.
2. Arnstein Ladder of Citizen Control which ranges from full partnership (self-determination) to manipulation. Sadly, "help" with respect to Autism seems to fall more in the latter.
3. Person Environment Misfits. The societal helpe focus seems more on "help" change the person and less "help" change the environment when it comes to Autism. 

https://vimeo.com/344483747

I can so relate with much of the above. Thank you Hannah. 

Over the Pond in Europe

Lovely Europe Vacation the past 2 weeks

Eating Belgian Waffles and Belgian Chocolate in Brussels

La Grand Place in the heart of Brussels with diff architecture styles.

The Atomium representing an iron crystal built for the 1958 World's Fair.

Handmade mechanical Cuckoo clocks in Black Forest area of Germany. Home of the cuckoo clock. Quite the sight. Never seen so many types before. Hundreds of them on the walls.

Enjoying the Spray at Rhine Falls

An ice cave at 10,00ft in the swiss alps

Helping to prop up the Broken Chair monument opposite the UN in Geneva.😜

Reminder to politicians visiting the UN about the dangers of landmines.

The Flower Clock in Geneva

The Palace of Versailles with its 2300 rooms. And the lovely 200 hectare Garden of Versailles around it with its fountains and sculptures. His old home, the Louvre, got too small for Louis xiv, the sun king. So he filled in a swamp near his old hunting lodge and built himself a massive new home.

Arc-de-Triomphe at the end of Champs-Élysées. The streets radiating out from the arch give it a star-like appearance.

Napoleon wanted to march his victorious army through this arch but was defeated in Waterloo long before its completion.

The immediate area around the arch is one of the most accident prone in the world so no insurance company will cover any accidents within a blue line drawn there.

Eiffel Tower looks the best at night all lit up and reflected in the Sienne river. It blinks for 5 mins on the hour between 11pm-1am too.

Had an awesome view of Paris from the top of Eiffel during the day.

Paris has some impressive architecture.

I guess you can touch the top of the I M Pei's Pyramid in front of the Louvre.

omg, we've all been lied to as preschoolers -
London Bridge is not falling down and has not for many centuries!!! 🤣

I guess once upon a time it was made of wood, but now it's a vanilla stone bridge.

Tower Bridge behind looked elegant. I guess most tourists confuse Tower Bridge with London Bridge.

The Tower of London houses the Crown Jewels

The queen certainly gets the biggest house.

Turns out she does not even live in London but in the city of Westminister. She has to get permission to enter London.

So, i been to London but did not get to look at the queen, unlike my grandpa who got to actually meet with her.

All I can say is that the queen was in the building when we toured Windsor Castle. The Royal Standard flies above to indicate she is in residence.

Nifty castle, very ornate and grand.

Part of me was kinda hoping to see a couple of cats (descendants of the ones who chased a mouse under her chair!!)

"Taking the waters at Bath"

- The Roman Baths at Bath of Jane Austen fame, where the aristocracy, gentry et al. gathered to socialize or be "healed" by the geothermal waters.

Later the doctors started promoting seawater over the Bath waters so folks started going to Brighton.

Sophisticated structures built around the subterranean geothermal spring waters at Bath during Roman Britain era were excavated much later on.

Unlike the rest of England with its brick houses, the entire city of Bath is built using the honey-colored limestone native to Bath - Bathstone - even the roofs. So the city has a rather interesting look.

Stonehenge in the Salisbury Plains

No explanation needed.

CBT for adolescence

Hari Srinivasan

Psych 135 Treatment of Mental Illness

Prof Alison Harvey

CBT vs CBT+ABFT for Adolescents with Anxiety

The intervention chosen for this paper was Cognitive Behavior Therapy (CBT) for generalized anxiety disorder (GAD). I am no stranger to CBT having gone to bi-monthly sessions to deal with my anxiety and mood disorder for most of my teen years while living in South Bay. Anxiety and depression come with the territory of the frustrations of living a life with a disability, autism in my case. 

What was interesting about this study by Siqueland, Rynn and Diamond is not only in its use in the adolescent population but also in trying to see if the combination of CBT and ABFT (Attachment Based Family Therapy) would have better efficacy than just CBT alone. ABFT attempts to also address the interpersonal relationship component that teens have with their parents. 

The efficacy of CBT is well supported by independent and well designed studies. The basic presumption of CBT is that thoughts and feelings influence our behaviors and vice versa. Ergo, changing our negative thinking will result in lesser anxiety.

The fundamental underlying symptom that characterizes GAD is excessive and uncontrollable worrying.  This worry is perpetuated by a cycle of “maladaptive thinking” about the idea of worrying itself. This catastrophic spiral of negative automatic thoughts means, an inability to relax and further maladaptive behaviors that include avoiding any situations, images or thoughts that may provoke worry. 

The need of the hour is cognitive restructuring which aims to modify the cataclysmic thought patterns and belief systems and the change the mistaken impression that worrying serves an useful function. Essentially, cognitive therapy techniques according to the study “focuses specifically on negative predictions about the future, and unhelpful attitudes about one’s ability to cope with difficult situations.”

For instance, one of my CBT exercises for several months was to  keep a journal of my thoughts every 20 minutes for 2 hours every day 3x a week. An example follows:

Thought: “Orientation schedule is making me dizzy. I’m gonna fall apart there.”

Feeling association with thought: anxious, scared

Cognitive Distortion: All or nothing - thinking in absolutes

Reframe: Go with do what you can then come right back home. 

Therapy techniques incorporate a scheduled “worry time” in order to control and limit exposure to the activities and situations that bring about worry. Pleasurable activities are also incorporated into the day’s schedule as well and the person is taught relaxation techniques. 

CBT techniques offer a controlled systematic exposure so that the person learns that their fears of negative outcomes do not necessarily come true. This means that over time, they experience a reduction in their anxiety. 

The study being discussed by Siqueland, Rynn and Diamond was done over two phases. The goal of Phase 1 was therapist training and checking the feasibility and acceptability of the combined condition (CBT-FAM). Phase 2 focused on implementing both the individual CBT and CBT-FAM.

Participants enrolled in the study were between the ages of 12-18 and had to meet the DSM-IV criteria for either GAD, Separation Anxiety Disorder or Social Phobia. A parent or caregiver also had to participate in the family treatment component. Participants were recruited through CARes (Child and Adolescent Research Service) at the University of Pennsylvania. Measurements were taken post-treatment and at the 6 and 9 month follow ups. 

The 16 session CBT for adolescents was modified from a standard manual designed for children (ages 8-13). There were 2 parent sessions as well. 

Skill building in the sessions focused on four areas ‘“(a) recognizing anxious feelings and somatic reactions to anxiety,  (b) clarifying cognition in anxiety provoking situations (unrealistic or negative attributions), (c) developing a plan to cope with the situation (modifying anxious self-talk into coping self talk as well as determining what coping actions might be effective), and (d) evaluating performance and administering self-reinforcement as appropriate.’’ Other behavioral techniques included contingent reinforcement and  relaxation techniques. A “FEAR” acronym was used - “F: feeling frightened/anxious, E: expecting bad things to happen, A: actions and attitudes that help, and R: results and rewards.”

The results of Phase 1 were not definitive but encouraging enough to proceed to phase 2.  The post treatment outcome for phase 2 showed that for CBT alone, 67% (4 out of 6) of the adolescents no longer met their primary anxiety diagnosis, while it was 40% (2 of of 5) for the CBT-FAM. When parenting variables are taken into account, the CBT group reported an increase in psychological control while the combined group reported the opposite. Follow up measures also favored CBT where 100% no longer met the diagnostic criteria compared to 80% in the combined group. Essentially the results for adolescents lined up with those for children in other studies, that is, two thirds no longer met their initial diagnosis

The study admits they were “not sufficiently powered to detect treatment differences.” The sample size was small and there was no control group. The study also failed include comorbidity such as suicide risk, OCD, Bipolar Disorder etc. However it did allow for the medication as long as it had been started 8 weeks before and would not be changed during the study.

It appears from the results of the study that CBT wins hands down as the treatment for anxiety disorders. However this has to tempered with the disappointment of the exclusion of comorbidity which is often the norm and not the exception in the real world when it comes to mental health. From personal experience I also have to wonder if 16 weeks is really enough.  Mental health is not like a infection that can quickly be killed by a course of antibiotics.The circumstances and challenges in one’s life keep changing over the decades and there may be some maintenance CBT required, in only to keep the person from slipping back. 

Citation: 

Siqueland, L., Rynn, M., & Diamond, G. S. (2005). Cognitive behavioral and attachment based family therapy for anxious adolescents: Phase I and II studies. Journal of Anxiety Disorders, 19(4), 361-381. Doi: http://dx.doi.org.libproxy.berkeley.edu/10.1016/j.janxdis.2004.04.006