Brain Damage, Part III: In the Clinical Dark Ages

In this entry of my brain damage series, I’ll provide a clinical example to convey how the cultural dynamics of stigma can play out in clinicians’ behavior.

Once upon a time, I acted as an advocate for a woman I’ll call Cindy, who was suffering from depression and cognitive difficulties stemming from the depression. The problem had cropped up after a number of traumatic experiences that apparently caused a weak link to snap, bringing out this vulnerability to depression. She assigned a new psychiatrist in the county mental health system. This psychiatrist cut off the stimulant medication that Cindy was taking for ADD.

Consider the timing. Cindy had just begun, as a first generation student, to attend junior college. She was in the middle of her first semester. It was a really big deal for her. What was the rationale on the part of the psychiatrist for stopping her ADD meds? “I don’t believe in stimulant medication.”

My role in this mess was provide some support to Cindy by attending an appeal meeting. The head psychiatrist was present, and was acting kind of agitated. His first order of business was to make sure I wasn’t an attorney. When Cindy fumbled and asked for something that wasn’t exactly kosher, the head psychiatrist let her have it with a booming voice (I mean a really booming voice), making her sound like some kind of criminal for daring to ask for this. The woman changed color, but stayed calm and clarified her intent, since he was putting words in her mouth (the straw man attack, as it’s called).

So not only are cognitive deficits to be ignored, but they are a great opportunity for brutal bigotry. At least for some people, even some who have attained a very high level of education, authority, and licensure. Another name I’m not putting in print, despite the temptation.

They understood that I was about to file a malpractice complaint with the medical board, and they restored her medication (maybe they would have anyway, but why wait and see?) But they never considered cognitive issues, but this turned out to be a key to her recovery. Mitigating for these issues in the mean time could have prevented a lot of distress, financial loss, and chaos in her life.

This is a good point to remind you that for many folks, stimulant medication may provide much-needed support for key cognitive functions necessary to hold things together for people who are struggling with some types of cognitive impairment. Also, a lot of brain injury recovery is about regaining abilities and habits that most of us take for granted. It’s a bit like amnesia, except that it is for mostly unconscious habits that are necessary for success. In Cindy’s recovery, I believe this was a crucial aspect.

By the way, please, don’t go away thinking I live to trash the mental health field. I hope that this will help everyone, in the field or not, to look for ways that they can transcend this dynamic and live a more meaningful life. I also hope that clinicians will realize that they have a responsibility to assess, refer, and treat these issues. By describing it from various angles, I hope that I am making the problem much easier to perceive, so that we can respond. I referred to this part as “In the Clinical Dark Ages” because there is so much progress that must be made just to be at a real starting point when it comes to addressing cognitive functioning in the mental health community.

In an upcoming part, I will talk about what can be done to help patch up cognitive problems or slow down progressive versions. In part four, I will give an example of how a family needed to clue into cognitive problems in a family member that would otherwise have led to additional serious problems.