Last updated on January 8th, 2024 at 10:17 am
In 1969 while in private practice I was awarded a 3 year, $164,000.00 dollar NIMH research grant on the rehabilitation of young adults with 4 or more years with disabling static brain damage (TBI, stroke, encephalitis etc.)
All subjects were living with their parents, were incapable of holding a job and all had formal rehabilitation following onset of their disability. The author was a psychologist consultant at the then St. Joseph Hospital in Wichita, Ks. for a stroke grant providing physical therapy, speech therapy and occupational therapy to acute stroke patients.
The author was impressed with the rehabilitation provided but he was concerned that the rehab provided did not include any attempt to rehabilitate higher level cognitive abilities such as complex problem solving, abstract thinking and the like.
This was not unusual because physical therapists, speech therapists and OTs, unlike psychologists, do not have any graduate training in higher level brain/behavior functions and these professionals provided services under the direction of physiatrists (medical specialists in physical rehabilitation) who accepted the views of neurology at the time.
Actually many neurologists at the time, and some even now, saw most of the recovery observed post injury or other static disease was a natural brain healing process that occurred the first year of recovery or at most 2 years.
My grant involved taking 30 unemployable individuals with static brain injuries 4 or more years post injury or disease, pre-testing all with the Halstead-Reitan battery (thanks to the eminent neuropsychologist Gerald Goldstein, Ph.D.) randomly assigning experimental rehabilitation for six months to half of the group and no rehabilitation to the other subjects for the six month period between Halstead testings.
Wichita neurologists and neurosurgeons were informed of the research that appropriate candidates would receive 6 months of additional rehabilitation without cost.
Despite the no cost rehabilitation not one neurologist or neurosurgeon referred any of their patients to the program; moreover, 2 or 3 subjects asked the researchers not to tell their neurosurgeon that they would be entering this experimental rehab program!
Apparently the conventional wisdom of neurology was that patients with static brain damage 4 or more years post brain injury were incapable of benefiting from such rehabilitation but our results found the conventional wisdom was indeed wrong.
On the pre and post 6 month Halstead performance of the control group, these controls subjects as expected showed stable brain functions during the interim, cognitively neither better or worse.
All control subjects after 6 months were still living with their parents and were still unemployed. 3 of the 12 experimental subjects after 6 months of rehabilitation were gainfully employed. A 4th experimental subject was considered employable but he wanted to first work for his GED before getting a job.
On the Halstead battery (the subjects of course were not trained on the Halstead tests) these subjects Improved on the more difficult test demands such as the Halstead Category test, the Tactual Performance Test, and Trails B, all examples of higher level cognitive and adaptive skills.
Prior to the 3rd year of the grant the 3 researchers (Les Ruthven, Gerald Goldstein of the VA and George Lewis of Wichita State University) presented preliminary findings of the grant at the American Psychological Association annual meeting in Hawaii in the summer of 1971 at 8 o’clock in the morning, the 1st day of the convention.
The investigators thought they would have a very small crowd at such an early hour but close to 90 APA members were in attendance including the eminent neuropsychologist Dr. Charles Golden of Omaha, Na. who continued the work the research grant started. Dr. Golden later called the rehabilitation neurotraining, perhaps because he working at a medical school.
What are Dr. Ruthven’s criticisms of neuropsychology and related issues?
First I was part of a small group of APA members who opposed APA’s move to establish a professional practice degree of psychology, the Phy.D. Prior to this move clinical and counseling psychologists were the only health profession whose training reflected both the scientific and practitioner model of psychology.
Training in how to conduct and evaluate scientific research sets psychologists apart from all other health providers and the Phy.D represents a practitioner degree with a lesser focus on psychology as a science.
The average physician, trained in a host of physical sciences but not trained in how to do science (or to critically evaluate health research) seems to the writer more in basing practice more on clinical and anecdotal “evidence” rather than sound research.
A number of us who were involved in the research and clinical practice in the development of neuropsychology were opposed to making neuropsychology a separate division of APA. This minority believed that neuropsychology should be a branch of clinical psychology and not a separate discipline.
A division of neuropsychology would only separate one from the other because both fields deal with brain and behavior relationships. At the time I believed a separate division would move neuropsychology away from clinical psychology and more toward neurology and I believe this has occurred.
Neuropsychology has followed the lead of neurology and both fields are essentially restricted to the diagnosis of static and progressive structural brain damage, neurology because neurology has little to offer in the area of non-structural brain impairment and unfortunately neuropsychology has been following in the footsteps of neurology.
It is true neuropsychology has been quite involved in the field of devising tests to assess mild cognitive impairment (MCI) but even here the attempt is to more efficiently diagnose structural brain damage while ignoring “reversible” brain impairment.
I put “reversible” brain impairment in quotes because at this stage we do not really know if a case of “reversible” brain impairment remains reversible or in the long term if reversible brain impairment can result in structural damage to the brain?
We know from research, however, that the longer patients are on drugs to treat depression or psychosis the worse the outcome! Psychiatric drug believers attribute this to the psychopathology involved but not the drugs; however, this is a criticlal research question that must be examined.
When APA recognized and established Division 40 (neuropsychology) many of us who contributed to the development of the new field were offered grandfathering to board certification in neuropsychology but I turned this offer down because I was so opposed to separating this new specialty from clinical psychology.
For the past 22 plus years, at least since 1987 (the year I started PMHM) I have spent a great deal of time reviewing what I call “everyday” healthcare with regard to treatment efficacy and safety.
The website Worst Pills News finds that there are 10 classes of psychiatric and “medical” drugs that impair the brain. From this and my reading of the health literature leads me to believe that probably 50% or more of pharmaceuticals impair brain functions at least while the patient is taking these medications.
When the brain is impaired the persons ability to learn is impaired. These brain impairing medications include most if not all psychiatric drugs and non-psychiatric drugs such as opioids, steroid drugs, anti-seizure medications, some cancer drugs, sleeping pills and others. I suspect the brain impairing “side effects” of these medications are the real “therapeutic agent” in treating or covering up the health problem.
Some patients on these brain impairing drugs complain of memory and “brain fog” problems (in some cases suicidal and homicidal thoughts) but too often medical professionals attribute the origin of these complaints to sources such as depression or anxiety and not to these drugs!
These discussions and controversy over the source or sources of these complaints have been going on for 70 years or more and we have virtually not made any headway in determining the brain or non-brain origin of these complaints.
To answer this research question we need a series of at least pilot studies assessing the patient’s cognitive functions before drug initiation and serial cognitive assessment during and following drug initiation and drug cessation. Clinical research psychologists are probably the best trained health professionals to conduct this much needed research.
Neuropsychology has some excellent diagnostic tools but these are designed to diagnose structural brain damage but not “reversible” brain impairment which is well below the threshold of structural brain damage.
One possibility to explore this field of “reversible” brain impairment is the Ruthven Impairment Assessment (RIA) an online computer performance measure of normal and impaired cognition, which at this time seems to have a lower brain impairment floor than current neuropsych batteries.
Clinical psychologists who would like to evaluate the RIA at no cost for research or clinical use should contact the author of this article.
