Bad Neuropsychologists Hurt Recovery after TBI

Bad Neuropsychologists are Biggest Challenge for a Brain Injury Lawyer

By Gordon S. Johnson, Jr.

Bad neuropsychologists undermine the proper diagnosis after brain injury and can often be the biggest challenge for a brain injury lawyer. A neuropsychologist is not a medical doctor, but a Ph.D. in psychology, who should have done a post-doctoral work in neuropsychology. Preferably that post doc work is done in a medical school setting.

A generation ago, neuropsychologists were the pioneers in the field of brain injury.  I owe much of what I know about brain injury to a trio of neuropsychologists who mentored me, answered my constant questions, nurtured my own theories of diagnosis and recovery. In 1992, the most important piece of the diagnostic picture of brain injury was the neuropsychologist. On my first major web page, I had this to say about neuropsychology:

Neuropsychological testing is designed to determine the brain’s capacity with respect to memory, abstract reasoning, attention, concentration, executive functioning, motor skills and other cognitive and psychological factors.

By comparing the pattern of these results, against the patients pre-injury functioning, then correlating the results with the type of trauma suffered by the patient, neuropsychologists can opine that individuals as to permanent deficits as a result of brain trauma.

But things have changed since 1992. First, advances in neuroimaging have given us much improved imaging evidence that the brain has been injured, even after a brain injury that did not involve coma. More significantly, the field of neuropsychology has been co-opted by a large group of doctors who are financially motivated by the insurance injury to blame deficits on malingering and secondary gain. Rather than the caring doctor who uses years of clinical judgment to recognize a pattern of symptoms that says “brain injury,” neuropsychologists are now the chief denier.
This trend began with mediocre research that was either funded by corporate or insurance interests or authored by neuropsychologists who made obscene sums as defense experts. They produced absurd research that labeled legitimately injured persons as malingerers or liars. If the results were too close to call someone a cheat, they would use the backhand label of somatoform diagnosis.
Ultimately, these neuropsychologists trained a generation of new doctors who found the statistical significance of answers to a few questions on small sub-parts of the neuropsychological test battery, to be more important than the real world change people were suffering after head trauma.  The worst of the new devices to label injured person’s liars and fakers is the Fake Bad Scale, contained in the MMPI-2. This scale compares the answers of injured persons to uninjured persons on questions that an injured person would endorse that an uninjured person would not. But rather than finding the different answers to support a finding of disability, the Fake Bad Scale attributes the increased endorsement to faking. Here is what a recent Court had to say about the Fake Bad Scale:

On its face, the Fake Bad Scale doesn’t make any sense. This is because this is a test that is supposed determine if a person is accurately reporting the symptoms that they are suffering or are they exaggerating or malingering. However, the test inquires about multiple symptoms persons would likely have if they in fact had their claimed. If the test takers report that they have the symptoms, those answers are counted as points towards malingering or exaggeration.

This test in effect says, if you report the symptoms that we would expect you to have if you have this injury, then you are exaggerating your symptoms or you are

The court finds this approach cannot possibly be scientific.

One can almost tell the quality of the neuropsychologist by the interpretation that neuropsychologist makes about the Fake Bad Test. The good neuropsychologists will probably not comment on the scale. The bad neuropsychologists will base their primary diagnosis upon it.
If your lawyer doesn’t understand this huge flaw in neuropsychology, you will have no fair chance at a fair recovery in the lawsuit and your recovery in real life will be hampered by this stupid label the bad neuropsychologist has put upon you.

Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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