Neuropsychological Assessment: DJ Part Seven
One of the neuropsychological assessment tests used in assessing brain injury is what is called an MMPI-2. There is a lot of controversy regarding this test.
The brain injury community must say NO to the MMPI-2.
No one who has survived a coma should ever be given the MMPI-2 or any other personality measure.
While its value in a Mild TBI is a bit more suspect, core to evaluating deficits and areas that need further therapy after a severe brain injury is a neuropsychological assessment by a Neuropsychologists. Neuropsychologists are not medical doctors, but doctors of psychology who have completed intensive post doctoral work in brain function and pathology.
You’ve had a neuropsychological assessment evaluation. Your first one was when?
January of ’06.
What were the findings?
There were several categories of neurocognitive deficits and short-term memory. They do a lot of different types of tests, the Wais III the MMPI-2 and they did puzzles where they blindfold you and you have to take like a round piece of wood and then on a board find the round spot and then place in there.
If you were to give someone who was 90 days from injury who was about to have a neuropsychological assessment what would you tell them about what was about to happen to them?
I would tell them to make sure that it’s a full-day test. We actually had somebody on our team HI-Level Facebook site recently say that they were going to get some neuropsychological assessment testing and then go (after) and get their shunt checked. I said I’ve done seven neuropsych evaluations and not one of them was less than a day. Most of them are a day and a half. So she came back and said you’re right, they only did the MMPI-2 which is more of a litigation play toy for lawyers and nurse case managers or whoever, insurance companies.
Why do you say that about MMPI2?
Well it’s, it can be used to determine – it’s the test that they determine whether somebody’s malingering or not because they’ll ask the same question over and over again every 50 questions. Do you love your mother 50 questions later, is your mother your best friend, 50 questions later, have you ever gotten in an argument with your mother. You know, it’s a test of something but I’ve taken it so many times now that it just, it’s actually kind of nauseating because it’s about 600 questions and it repeats constantly.
What have the neuropsychologists told you about your neuropsychological assessment or MMPI profiles?
I don’t think they discuss them. I think they discuss the neurocognitive deficits more than that. I mean they just say that your memory, your short-term memory’s bad. There was some discussion, that nurse case manager I met in November of ’05 said that I was a 12 drink a day alcoholic as reported by my parents who never reported anything like that. Once again that’s just another case of bending the truth a little bit.
It was proven in one of the neuropsychological assessment evaluations that long-term memory was almost intact. I mean you can see how much I’m filtering to you about my journey and, you know, long-term memory but you asked me when we came back on what were we talking about? The short-term memory’s just not there. So they determined that the long-term memory deficits cannot be from alcoholism or anything like that, so I was, I was very happy to read that.
The insurance industries generation long effort to redefine down the standard of medical care to increase profits, has also impacted care for the survivors of brain injury. While only a small percentage of TBI survivors are able to receive significant compensation for their injuries, the tactics employed by neuropsychologists in those cases have practically ruined the field of neuropsychology. Rather than assessing the real world deficits and focusing on therapy and vocational options to regain function, such doctors with the greatest expertise in brain injury, have become hired guns of the insurance lobby. More tragically, research is focused more on malingering tests than brain injury symptomotology. Real science to find a path to a cure has been replaced by a morose fascination with identifying “fakers.”
No one who has survived a coma should ever be given the MMPI-2 or any other personality measure, as these tests are not aimed at a patient base with so many real deficits. Essentially, the MMPI-2 neuropsychological assessment uses a computerize scoring system, to flag people who have “extreme” reactions to its long list of innocuous questions. Well, someone who is recovering from catastrophic damage to his or her mind, will not be “average.”
The brain injury community must say NO to the MMPI-2 ,neuropsychological assessment test. It has no place in brain injury assessment and its malingering scales are nothing but a defective diagnostic tool that can seriously impede recovery. In the hands of poorly trained or unethical psychologists and other clinicians, it can cause additional catastrophic emotional problems.
Assessing mood requires consideration of the interplay of organic injury with stress and emotions. No light can be shown on such an individualized dysfunction, by a test designed for non-brain injured population. Psychologists need to put that defective tool away and focus the diagnostic/treatment paradigm on real world challenges.