Sunday, May 10, 2026

Legacy Prose by Keith "Buster" Torkelson, MS

 


Dear God,
 
Where is - Are you?
Are you with me tonight?
 
God is stretching
Out his spirit
To reach me, tonight
From his center of All
 
Is he with Candace also?
Craig?
Kevin?
Lanaii?
Christ-ine?
 
Is God in King-size
With Mom and Dad?
 
I’m finding God may not be in me
Yet above, about me
Possibly with my Essence of Pre-conception
 
Feeling some warmth
Feeling some hope
I feel some authentic Love?
 
What?
Am I actually here for?
What has been and might be
My singular contribution
Of merit
Of record
On this World
 
Can God be in our plane: x,y,z
In our existence
About our commonalities
 
Am I here?
Am I here to enjoy?
Giving?
Taking?
From her, big mother Earth
 
God’s Time or Time separate
Our Life or Life apart
 
God
I ask you?
What now should I do and
Not ever do again?


Never have we appreciated his face
Maybe
Because
I’m inside him
Can’t see outside
 
I am like an 80s ribosome
In one of Gods
Hepatocytes
In the liver of God
 
I help him to make
Things
Over which he has
Indirect control
Over me and mine
 
I believe if he dies
As Nietzsche supposed
I may pass to
Moving next door to
Nothing’s domicile
 
Life is infinity
With an exponent of zero
One
Our constancy fades to
Nothing degrees Kelvin Land
 
And now a new “One”
Might ascend
To the throne
Of a future
Kingdom
 
Oh!
Yes, I believe
In
God
Amen, So Be It


God
Help us…
I am listening to
James Bond (JB) themes
 
To one
I played
I danced
With Ms. Bunny Rabbit
She liked it
 
Rock’ in with Mr. Hound Dawg
He like it
Now we be rock’ in
To J.B. jazz
 
I went and obtained
Some more brews
My life is such a trip and fall
Used to be depressed
Now
Some good time
 
Let me fill ‘em up
Some of these paginas
Aqui
Yo estoy aqui
 
Ah
Miracles
Called
853-1212
Its 1:34:50
That time lady
Just never grows old
 
I don’t even know
Where I am going
Or what to do
 
Considering
Going to the NA meeting
At South Coast Hospital
Tonight
It is East Meets West
Meeting at eight
 
After I am returning home
Sleep at nine fifteen
 
No drinking
So I can drive sober
No sense getting busted
Going to a meeting
 
Let us talk
NA
That is Narcotics Anonymous
For the novices
 
In reality, to truly be clean
I need to give up all forms of drugs
Alcohol, nicotine, and caffeine
In addition, I need to sublimate
 
Sleep then running
I used to run like a cat
I really enjoyed that
Feeling rather strong
 
Now I can’t even handle the possibility
Of getting my heart going
From a very cold stop
Yet as Jack Terrill stated
From Russia with Love
Suffering must be so we can
Know pleasure
 
But I am Mellow dead
And I cannot even think
“About Saffron”
Now that is a derailment
When am I going to start again
Learning to write, right
No that is wrong
After a sixar
I be sleepin
I am carrying a slight buzz
I only live once!
 
My kidneys hurt
In the mornings
My brain hurts
In the morning
 
But I feel good dancing and singing
Good at this moment
Cause I really have lived once
And I pray I can stop
Before I’m dead
Not looking to tomorrow
I am in “the second”
Earth, please, help me
With this next life
Cause I do not want to like die again
 
Let me kill this schizoid paradigm
Or doctrine
“Reality Testing Intact?”
I’m writing for pleasure
And salvation
 
And if the fates decide
I die, I’m dead
I want to go away
And awaken on a day
Without habits
And urges
To smoke, drink, dip
 
The genes are working against me
Some say
I wish to mourn like a
Grazing animal
An antelope
Or maybe an Aurochs
Pissed I be at “The Fates”
 
I have no true mythology
Ah!  Yes!
I be lying to myself
Cause at times I
“Ain’t nothing but a hound dawg”
Am I King of Dawgs?
 
Do I feel you with me?
The loyal bugger she was
Henry the “Little Lost Dog”
AKA Perodita, Lady, Pare, Hank
A love in my life
I hate it when something dies before me
 
I loved girls once
I think
What will I do for one?
Not Die
 
Looking for electro-love
I reached a few in time
With some I believe we had a thing
Called “Radar Love”
“No More Speed I’m Almost There”
“Not Quite Right”
 
Wishing to
Make a “Love Connection”
After death?
For sure I will connect back with
Mother Earth
 
I try not to make you guess
Zolada means Gold in Polish
I think
I had a little Gold once
I pounded it to a lump
I marveled at it
Then sold it
 
Females
I have observed thousands
What do Men See?
I know what I see
Some things are stimulating
The forms and grace
The “I want you to look at me non-verbal cues”
Like pumps
 
God thank you for the last girl
Some girls are best seen
Geologically
Mother Earth
She be
The biggest and possibly
The best girl I know
 
Traditional and contemporary at the same time
A real go-getter
Men be there and meet the dirt
Yet run there as slow as you can
Unless you are under unbearable pain
Signed TorkASaurus
REX for short
 
Onward Christian Soldiers
To the last pagina
Pagina de musica
Grandiloquence
Embellishment
Ethnic
 
Why do writers write?
They hate the return key
To always look for
The missing link
 
I know what that is
You don’t?
What do you know?
Cause I don’t
Oh! I gather what it is to know and use
Is empathy and compassion
For those who never had a chance
Born to hell
And only going deeper!


This song is for people
It’s for people like you
 
This song is for the ordinary
Civilian and soldiers to
 
This song is for those alive
Who can actually read it
Like you, some others, and me
 
This song is for the
Successful
In whatever that may be
 
This song is not just for Mel
Or Madonna
Though this song they could sing
 
This song is for parties
Especially those that encourage you
To sing for All to hear
 
This song is for people
Americans, Soviets, as well as the rest
 
Mostly
This song is for authentic friends
Like me and you
Like me and you
 
You and Me!
Us


I’m finding her so attractive
Her lips taste great
I’m in a sort of
Love with my
New friend
 
Maybe she will become my
Girlfriend
Hasn’t had one for a long time
Not really since Katy & Leanna
 
This new girl
Her name is Jody
I really thank her
 
For making the first move
Ending my paralysis
And the untouchable
 
I’m thinking of her right now
Of course
Deep inside me
That part seems to connect
With her
 
I think she knows me better
For better or worse
Often
Cuts me slack
Lets me take two steps back
Into the light of reason
 
Thinking
That Mr. Jones knows her song
Better than I
Because she counted crows
Before me
 
In a manner I identify
A bit
With
Mr. Jones
 
I take it he says to me
Get close to her
Yet retain comfort
In a way her first move
Was a remedy
For my condition called
Never going to move first…
 
She said “Kiss Me”


As I hear your whispers
Sometimes I am lost
 
Trying to do right by you
I know its good
When I see your smile
When I see your smile
I elevate to feel glad
 
At times I feel
I am not clear
I try to help with the goals
You are trying to attain
 
In my best moments
I will give you aid
I will offer you inspiration
Yet I know you will make it
Anyhow
 
I think that I am honored
To be your friend
Yet to tell the truth
You often scare me
 
If some of your
Sad faces could speak
Without an attack
Maybe I would not get trashed
By your truth
 
Even if apart
I believe
That I will always be
Your complement
 
And in the events
That you
Release that temper
I hope myself composed
That I may remain cool
And listen, and possibly act
On your requests
 
I can close my eyes
Though you are not here
I see you
Especially your full lips
 
Often I feel slow
When addressing
You
Yet there is so much for me
Still to know
Always learning with regards
To you
 
You’re not the best teacher
Am I helping you?
My goal is to reciprocate
Offer you new options
I’ve tried to help you
From the first we met
 
I have reservations
Because of our pasts
I wish that my attraction
May keep us on track
 
One final word
A compliment
From a complement
Katie you are beautiful


I was born
In spring of ‘59
In the Golden Valley
Of Minnesota
 
I took my first breath
Reportedly
Sometime near 9 pm
On Sunday
Easter Sunday
March 29
 
About three years later
I sort of died
My sister
Christine
Pushed me away from
Her in the Pacific Ocean
At Huntington, California
 
The water was well over my head
She had dragged me out
Past the sandbar
On my own
I sank
Once
Struggled to the surface
Just to sink again
 
I woke up on the beach
On my side
With the saving
Lifeguard peering over me
 
On the bottom
Just after I had gulped the water for air
The adrenaline gave me a warm peace
I died for a moment
Gone no memory
Until the beach
Thank you Chris
 
Years went by before I came close
To dying again
Somewhere around 1979
I had drank a little more than usual
I lay down and I already felt
Overdose and the main volume
Of EtOH had not even been absorbed
 
I fell unconscious
A light unconsciousness
Yet soon I felt
A squashing
The Weight of the Devil
I felt on my chest
So hard it stopped my breathing
 
I faded away
Till uncle Pat found me in spirit
And led me back
 
I awoke in the morning
Just knowing how close
I came to not
 
Two close to deads
In the first half of life
I had hopes of all hopes
That these were the end
 
Until the true end
Me, at a ripe old and golden age as a sage


I really wish to die
Actually be euthanized
Tonight at eleven pm
 
I have a simple request
That the mediator
Provide me with a dying dog
 
No
It’s not the dog that is dying
It’s a dog to die with
To hold during the passage
 
So I may feel in my
Last
Warmth and comfort
Peace and calm
And in the final moments
Relieve my life’s pain
 
Miraculously she takes
What not they have offered to bare
As she, my dying dog, nestles
Near my heart
 
I’m thinking right now
That the
Dying dog, a girl
Small dog
Lovable and loving dog
Is with me I wish
To release, pass
And dissociate
 
To die with something
From which I can feel
Real love
From her
This dying dog
 
Now to God I pray
Please send me my
Dying dawg
And a skilled euthanist
Now
Before hell returns
As losing control
Of my mind, heart, body, and soul
 
Amen, So Be It


I awoke this morning
With my kitten
A real pal
He is
This kitty
Who maybe I will name
Serenity
 
I watched the sky
Clear to blue and
Crystal clear after a rainstorm
 
She is out there
The beauty I need
The girl to share
My bed and home
And my peculiar wealth
 
I’m needing love
With which I
Will kiss her carmine lips
Caress her spirit
Will listen and learn
Of her odyssey on this rock
Our mom, Earth
 
I will offer a rose
Smelling so sweet
A rose of white it shall be
For purity
 
Then propose in my manner
To commit for life
To care
And be kind to her
 
Her name is “True”
She can stand alone
Though she reaches
Over to me
For
Honesty
Loyalty
Patience
 
I can tell her what I feel
For real
Glad
Sometimes mad
 
I’m hoping to never hurt her
Yes that is my ideal
 
With her I will dwell in
Yet another house
A home in a home of
Of God the Father
 
I ask him to
Give me away
And may we discover love
Everlasting
Not even in
Death
Do Us Part
 
Cause we will then
Be one and another
In the kingdom
My queen
And
I
The woman of my dream
 
Now back
To that
Cat
That sits purring on my chest
A slip this was into
A dream of the day
A daydream



I invite your being
To visit again
We share space
I can’t see you anymore
Because you’re passed the point
Of unlikely return
 
I ask you
Is this His water you drink?
Do you release it changed?
In composition
As we do
Here in 3D (Death-Disaster-Disease)
 
You move towards
Me for a day
Then passing
He let you die
I dream you were in no pain
 
We remain behind
In this potential
Heaven on Earth
 
You awaken
In a new home
In his
Holy Kingdom
 
We remaining here
Sleeping
While you celebrate
Release and
Meditate
On his principles
 
You might feel
We taste
You may touch
We smell
Do you still hear?
 
I believe I am
Beginning to see
My nature of being
We are A-men
Short lived
Possibly eternal
 
Know in a manner
I loved you
As I loved no
Other
 

Oh! Lord
Hear these words
Of mine
 
Today I am looking
For love
I have been searching
All my life
From the day I open my eyes
 
Lately I discovered
That you
Lord
May be the one
I needed and need
The most
 
Oh!
Lord
Hear these words
Of mine
 
Offer me patience
Infinite
Because I just feel
The best
Is yet to come
 
In time will you
Show me
“The Way”
And your way
 
You I believe are
The One
All
The one who feels
Just – Right
 
Amen



They took me by storm
I entertained them with notions
Notions of a planet of love
Love energy
Energy to conquer all pain and evil
 
I am on the payroll
The company is called All
Except Nothing
Nothing is another
All-together
 
I fly the banners for
The God of All
The Son of God
The Mother of God?
Or the Mother God created
Earth
 
I’m saying to you
Earth
I wish to help preserve you
Transfer as those Celestine’s say
Positive energy
 
Energy from beyond
Energy that begets order
And the order that
Begets energy
 
They took me by storm
Those men, plus
Implying that
I may have got the time
 
Time to
Heal, grow and evolve
To stabilize in security
And find psychic unity
To be One
 
Impossibly
Though
Not to be “The One”
That thought was a
Big mistake of mine
Pointed out for me
In a visit from the Men, Plus


Many times
I’m sitting
Up
Eating my environment
 
Amusing
 
Many times
I’m lying
Down
My environment eating
Me
 
Fun
 
Now
Having more
Energy
Thinking more or
Less
 
Need joy and mirth
To delight in mirth
Need time for laughter
Jollity
Glee
 
Now I harness much, less pain
And things that drain
Me
In reality
Still not
Joyful
But breaking through the bluntness
I feel
Some pleasure
 
Now for me
That pleasure is
Treasure
Tossing out
Much of the old
Working
Turning over
Acquaintances
 
Gathering and mustering a new
Hope
A new order
A new economic plan
A new deal
 
Reforming and creating
In the name of light
That identifies what
I really need now
To Succeed
 
Satisfaction
In obtaining
And retaining
Security
And a promise that all will be well
 
Before, at, and after
The END…



I release emotionally
I release spiritually
Both
In the Realm of Contrast
 
I now know
My differentials
 
Beginning
To feel the better feelings
Even pleasure from time to time
 
Yet I am still inundated
Feeling the harsher feelings
 
Deep sadness
Strong anger
I see no catharsis this week
 
Grateful though
For the healing I found
And received
 
Less pain coming in
More pain processed
Into passions
Especially a passion for healing
 
I never can seem to cry anymore
Even when indicated
I must
 
I haven’t had the positive antilog
Balancing my painful feelings
And the pain itself
 
I have little pleasure
To negate the pain
 
The contrast
Feeling the differential
Would bring tears to a normal
 
No sense of permanence
To counter the loss, the sadness
The frustration
 
Little peace or serenity
To contrast the anger
Little health
To contrast with
My hurt
Little love
To contrast and kill the fear
 
No catharsis in
My visions
Today


Thinking
My neighbors downstairs are moving
Their teeny girl
Playing the bassy music
Rumbling through my floor
 
Driving me bonkers
I hope a quiet group
Moves in below
In 187
 
Now
In the in between time
It is wonderfully peaceful
Downstairs
And up here in 287
 
Had a wild dream
I had a bug
A cat
In a tenement
 
Now
I have downed
Nine beers
At best
I will get sick
 
This alcohol is
Such non-sense
 
Hope to score
Some bong-hits
Manana from GG
In Orange
 
A stoned KET
How will Joan
Take him?
Like the girls before?
Wendy and Katy


I called my girl
Joan
A moment ago
Eight ‘o five AM
She answered
 
I said, Hi!
 
She said,
I know you are real busy
Starting your new life
I am starting
My new life
This morning
 
She said,
I wish you the best
Of luck
Keith…
 
Then a click
And she hung up
 
I feel lousy
Very sad
Tears forming in my
Eyes
 
Why did she do that?
Cause she was afraid?
That I would do it
Maybe
 
Joan
I hurt before you
Got hurt with you
I try not to hurt others
Cause I am hurting
As you have
 
I actually liked her
At times wanted
To be
With her
Till the end…



I Never really laughed much
Remembering comedy
And comedians
At The Laugh Stop
In Newport
 
They could get me
To laugh
Laugh
Till
My gut ached
 
I don’t laugh much
Anymore
I think laughing
Really stopped
 
For the
Haldol Man
And the
Navane Crawley Man
 
Right now
It is August
Thirtieth
Two thousand
And two
 
Though
I don’t laugh
Much
I have a lot to be
Happy about
 
Yet I wish I could really
Let out a good healthy
Hearty
Laugh!



Holy - Holy
Girl energy
Magnificent
Stupendous
 
An exclamation part
The power
And the glory
 
How did they begin that song?
Ponytails in gales
Hair down to their rears
 
Smokin
Only on Saturdays
That prime spot
And the floor exercises
 
The girl
Her energy
And me
 
With forms that only complement
Their girlish minds
 
Working for
Touch Co. Unlimited
Please squeeze me as I am
Warm and fuzzy
 
Where do we go now?
Stimulate our senses
OO-OO that smell
My memory of her grows stronger
As the day extends longer
 
Our hearts on fire
Setting free
That - Girl energy!


Thursday, April 16, 2026

Functioning 2026041601– By Keith Torkelson MS, BS V Torkel

  


Contents

  • Codes
  • GAF Summary - Data
  • Development Stream
  • Dis-functioning and Mal-Behavior Score 10 Items (LSF)
  • Social Behavior Benefit Status Score 15 Items (HSF)
  • Content
  • Timeline – Key Events & Major Milestones
  • Signs & Symptoms Screener 9 Items (LSF)
  • Severity of Symptoms Qualitative
  • Content
  • Functionality Comparison
  • Excerpts from 2 Articles





Note
20170602-F: Copied as whole into: Assess_GAF_17060204_Results
 
Global Assessment of Functioning (GAF) – Axis V – History
Result - Functioning/Severity of Symptoms

Date

Eligible Professional

Result

Note

2011 AVG

Alan Vu, MD

60/65

Registered student @ Cypress College, Outcome 4.0 GPA

201201

 

 

Non-sleep Able Environment Cascade

Begin Catastrophic Losses

20120319

HCA: Wilfert, MFT II

40/NR

 

20120420

Ravinder Singh, MD

30/NR

 

201205

“Doctor” Daniels

 

Temp practitioner

Fails to sustain Clozapine

20120518

Thymes, MD

ER Doctor

NR

Not Reported

20120607

Bum-Soo Lee, MD

35/45

Western Med Anaheim

Prescribes Restoril to compensate for no Clozapine

 

During 2012

Unknown

 

SSA Declares Lower Functioning & Cannot manage money

2013 May

DSM Changes

 

GAF Dropped

During 2014

Bum Soo Lee, MD

 

 

“You look better”

“You are a nice guy”

20160815

Self-Score

70/NR

 

2018

Rimal B Bera MD

 

New doctor does not report GAF, SOFAS or WHODAS

20251015

Rimal B Bera MD

78/NR

Asked him to report

 

Table of GAF Scores for Keith E Torkelson (2011-2025) – Last Updated and Reviewed: 20260415-W:


Shared In
05_Daily_Assess_Satisfaction_18081301_OCHCA
GAF (MSG) Adaptation - Impairment Summary (GAF-MSG-Beta 9 Item Screener)

 

Assessment Considerations

 

  • GAF
  • GAF Derivations
  • SOFAS
  • WAI
  • WHODAS

 

Quantifying Gains and Losses

Impact of Losses versus Gains

Losses have a greater psychological impact than gains, a concept known as loss aversion, where the pain of losing is often twice as intense as the pleasure of winning. While gains feel good, losses drive stronger emotional responses, often causing people to act conservatively to avoid losses, even at the cost of potential gains.

Development Stream


Table - Behavior Inventory – Functionality
GAF (MSG) Adaptation
Dis-function Assessment 10 Item Screener
Buster Evaluating Buster


20200406-M: Low Scores are Favorable

Progress setting things Right

Progress setting things right is characterized as a process of continuous, incremental improvement rather than a single, perfect leap. It involves taking "messy action" to correct mistakes, learning from failures, and focusing on consistent forward motion over perfect execution.

Baseline for Corona Scare

As of April 2026, COVID-19 shows low, stable activity with nationwide declines in infections, though it remains a lingering threat with seasonal surges. Over 99% of the U.S. population has some immunity, meaning the virus generally causes less severe illness than at its peak, shifting the focus to protecting high-risk individuals.

Metadata > [ORIGIN]
04_Case_Study_Mikel_Roby_19052901_Notes I
13_Media_Case_Mikel_Profiling_19081202_Working V2020
 
Table - Behavior Inventory
Social Behavior Benefit Inventory 15 Items (Functionality)
HSF = High Scores are Favorable
Buster scores Buster


First Generated: 20190814-W: 20200406-M: Baseline before Corona Threat

Catastrophic Baseline at time of catastrophic losses

A "catastrophic baseline" at the time of catastrophic losses refers to the new, elevated level of expected losses that insurance companies and risk managers must now use for forecasting, as historical averages are no longer adequate to predict the frequency and severity of modern disaster events.

A Medical Necessity

Medical necessity refers to healthcare services or supplies needed to prevent, diagnose, or treat an illness, injury, or its symptoms, adhering to generally accepted standards of medical practice. It must be clinically appropriate in type, frequency, and duration, and not primarily for the convenience of the patient or provider.

Meaningful Engagements

Meaningful engagement is the respectful, equitable, and active inclusion of individuals—particularly those with lived experience—in decision-making processes, shifting power from institutions to people to improve outcomes. It transforms participation from passive consultation into collaborative, purpose-driven action that values diverse expertise, fosters trust, and builds relationships.

Aside - Impact of Corona Scare

The "corona scare" (COVID-19 pandemic) caused a 25% increase in global prevalence of anxiety and depression, driven by isolation, fear of infection, and financial stress. It profoundly impacted mental health, particularly among women, youth, and healthcare workers, while triggering massive economic disruptions and a shift to virtual communication.

Life-Long-learner

Graduate Programs ...A lifelong learner is an individual who voluntarily and continuously pursues knowledge for personal or professional growth, driven by curiosity rather than necessity. This mindset embraces learning as a lifelong journey, utilizing both formal education and informal experiences to adapt to change.


Aside - 20190812-M: Update in the face of Mikel


GAF Interpretation

71-80

If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational or school functioning (e.g., temporarily failing behind in schoolwork).

61-70

Some mild symptoms (e.g. depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

Catastrophic Loss as Indicated by Global Assessment of Functioning (GAF)

A Global Assessment of Functioning (GAF) score of 40 or below indicates severe, catastrophic impairment in functioning, social, or occupational areas. Scores in the 1–30 range suggest severe danger of harm to self/others, inability to communicate, or gross impairment in daily living, often requiring hospitalization.

Catastrophic Loss as Indicated by Incarceration

Incarceration represents a catastrophic loss, causing profound, long-lasting damage to individuals, families, and communities, often creating "collateral consequences" that extend far beyond the initial sentence. It results in severe mental health deterioration, such as PTSD and depression, economic ruin, broken family bonds, and lost opportunities for housing and employment.

DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the U.S. and worldwide, published by the American Psychiatric Association (APA). It provides a common language for diagnosis, outlining criteria for each disorder to improve consistency in clinical practice, research, and insurance. The most current version is the DSM-5-TR (Text Revision), published in 2022, which includes updates and clarifications to the original DSM-5.

SOFAS

The Social and Occupational Functioning Assessment Scale (SOFAS) is a 1-100 clinician-rated scale measuring an individual's level of social, occupational, and school functioning, specifically excluding the severity of psychological symptoms. It was derived from the GAF scale, with higher scores (91–100) indicating superior functioning and lower scores (1–10) indicating severe impairment.

WHODAS

WHODAS-The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is a 12- or 36-item tool used to measure health and disability across six functional domains (cognition, mobility, self-care, getting along, life activities, and participation). It assesses difficulty over the past 30 days, producing a score from 0 to 100.

Retirement of the GAF

The Global Assessment of Functioning (GAF) scale was officially removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), released in 2013. It was replaced due to concerns regarding its conceptual clarity, questionable reliability, and lack of clear guidelines for use in clinical practice.

Workability Assessment Index

The Work Ability Index (WAI) is a validated questionnaire-based tool used to assess an employee's perceived ability to perform their job, considering health, mental resources, and job demands. Developed by the Finnish Institute of Occupational Health, it rates work capacity on a 7–49 point scale, categorizing results from "poor" to "excellent" to guide occupational health interventions.

 


What is the hallmark of a mental health episode?

The primary hallmark of a mental health episode, particularly a psychotic episode, is a loss of contact with reality. During this time, a person's thoughts and perceptions are severely disturbed, making it difficult for them to distinguish what is real from what is not.

Does hospitalization delineate a mental health episode?

Yes, hospitalization is generally considered a definitive marker of an acute, severe mental health episode. It serves as a clinical threshold indicating that an individual's symptoms have become too severe for outpatient management, posing a safety risk to themselves or others, or resulting in an inability to function.

Reality Testing Intact

Intact reality testing is the psychological ability to accurately distinguish between internal mental experiences (thoughts, feelings, perceptions) and external reality. It involves recognizing hallucinations or delusions as false and maintaining an accurate, logical orientation to the world.

Matrix - Severity of Symptoms – Tracker

“How are your symptoms”?

Table – Severity of Symptoms for Keith E Torkelson

Notes - 20140311 – TU – Appointment w/BS Lee MD
GAF - NSR = Not Spontaneously Reported
About Moving > “It is up to you”
Wellbutrin PRN trial denied
“How Satisfied Are You” Assessment Results
201606 – Titration off Ativan


Matrix - Severity of Symptoms – Tracker - Qualitative
“How is your situation”?
20160811-TH:


 FYI - HRE = Health Related Engagements

 

How is it treatment days?

Treatment days, particularly for cancer or chronic illness, are structured in cycles consisting of active treatment (drugs or therapy) followed by a rest period, designed to manage disease while allowing the body to recover. They can last from a few hours to a full day, often involving procedures like chemo infusions, with side effects, such as fatigue and nausea, that can develop in the days following.

FYI - What Is the Global Assessment of Functioning (GAF) Scale?
Written by Matt Smith - Medically Reviewed by Smitha Bhandari, MD on January 16, 2025
https://www.webmd.com/mental-health/gaf-scale-facts
 
FYI
https://iaap.org/wp-content/uploads/2020/01/GAF-Scale.pdf

GAF = Global Assessment of Functioning - Interpret Range 51–60

Moderate symptoms (e.g., flat affect and circumlocutory speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

Range 71-80

If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational or school functioning (e.g., temporarily failing behind in schoolwork).

 

Aside - SOFAS - Social and Occupational Functioning Assessment Scale

http://www.kenniscentrum-kjp.nl/app/webroot/files/tmpwebsite/Downloadable_PDFs_Instrumenten/sofas.pdf

71-80

Slight impairment in social, occupational, or school functioning (e.g. infrequent interpersonal conflict, temporarily falling behind in schoolwork).

51-60

Moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

41-50

Serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job)


Global Assessment of Functioning (GAF) Scale. (From DSM-IV-TR, p. 34.)

Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical (or environmental) limitations.

Behavior Inventory – GAF Driven - Functionality

Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).

QSM GAF (Mikel Roby)
20190812-M: Offering GAF = 30 at best
We had high expectations for Mikel.

Associated Documents > Metadata >

GAF_14010603_Tracker_DAG V2019-Results

20190812-M: Functionality Comparison


Having a Low Functioning Roommate

To handle a roommate with low functioning abilities, communicate openly, be patient, and set clear expectations while focusing on their well-being. You can try to be more patient with their processing time and communication style, offer support without being patronizing, and address any specific issues directly and calmly using "I" statements. If the situation is unsustainable, you may need to have a broader conversation about the experience or speak to a university or accommodation authority.

From > Metadata >
ParaSocial_Surveying_Ref2008082102 v2016
The actual process of rating the global assessment of functioning scale .  K . Yamauchi
Comprehensive Psychiatry - Volume 42, Issue 5, September 2001, Pages 403–409
http://linkinghub.elsevier.com/retrieve/pii/S0010440X01415586
Copyright © 2003 Elsevier Inc. All rights reserved.

Abstract

GAF & Others

The Global Assessment of Functioning Scale (GAF) was developed for the overall assessment of psychological, social, and occupational functioning. While the advantage of the GAF lies in this comprehensiveness, questions have been raised on whether clinicians rate appropriately. To clarify this issue, the actual process of how clinicians assign GAF scores was investigated. A total of 2,462 inpatients of 19 psychiatric hospitals in Japan were assessed by their primary psychiatrists using the following rating scales: GAF, Brief Psychiatric Rating Scale (BPRS), World Health Organization Psychiatric Disability Assessment Schedule (DAS), and physical Activities of Daily Living (ADL) index.

Aside - Functioning and Severity of Symptoms

A tree-based model analysis (also referred to as Automatic Interaction Detector [AID] or Classification and Regression Tree [CART]) was used to construct a statistical model with the GAF score as the dependent variable. The statistically best-fitted tree to predict the GAF score is as follows. The first split is based on the “conceptual disorganization” score in the BPRS, followed by splits based on DAS item scores, such as “conversation” and “underactivity.” The tree model obtained suggests that Japanese clinicians judge the level of global functioning by integrating the information on both the severity of psychiatric symptoms and the level of impaired behaviour and social functioning. This logic structure was clinically acceptable and agreed well with the concept of the GAF.

From > Metadata >
HHS_Measures_GAF_Ref_20090822b V2020
 
Evidence for limited validity of the revised global assessment of functioning scale
https://www.ncbi.nlm.nih.gov/pubmed/8837160
by P Roy-Byrne - ‎1996 - ‎Cited by 126
Psychiatr Serv. 1996 Aug;47(8):864-6.
P Roy-Byrne, C Dagadakis, J Unutzer and R Ries
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA

The study examined the concurrent validity of the revised Global Assessment of Functioning (GAF) scale, which is highly similar to the Social and Occupational Functioning Assessment Scale (SOFAS) in DSM-IV and which is designed to measure patients' functioning and not their clinical symptoms. Psychiatrists used the revised GAF to rate 337 psychiatric inpatients; the ratings were compared with nurses' ratings of the same sample using Lehman's Quality of Life Scale. Ratings on the revised GAF were most strongly correlated with ratings of clinical symptoms, not functioning. Reliance on the GAF as the only tool to assess patients' functioning may be problematic.

Summary

>As of May 2026, we are retiring our efforts around Functioning.  We will continue our work on Competency in the face of end-of-life planning.  In the end, we accept the GAF score that Rimal B. Bera, MD assigned us.  Buster is 67 now and does not foresee any significant improvement in his GAF and SOFAS.  Buster is relatively well off compared to his 2024-2026 Harvest Retirement cohort.  Buster still drives the car and is satisfied with his current living arrangement.