Neuropsychotherapy and Community Integration: Brain Illness, Emotions, and Behavior

376 Pages·1999·18.859 MB·English

by  Tedd Judd (auth.)

Neuropsychotherapyand
Community Integration
Brain Illness, Emotions, and Behavior
CRITICAL ISSUES IN NEUROPSYCHOLOGY
Series Editors
Antonio E. Puente Cecil R. Reynolds
University of North Carolina at Wilmington Texas A&M University
and Bastrop Mental Health Associates
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CONTEMPORARY APPROACHES TO NEUROPSYCHOLOGICAL ASSESSMENT
Edited by Gerald Goldstein and Theresa M. Incagnoli
DETECTION OF MALINGERING DURING HEAD INJURY LmGATION
Edited by Cecil R. Reynolds
FAMILY SUPPORT PROGRAMS AND REHAb~LITATION:
A Cognitive-Behavioral Approach to Traumatic Brain Injury
Louise Margaret Smith and Harnish P. D. Godfrey
HANDBOOK OF CLINICAL CHILD NEUROPSYCHOLOGY, Second Edition
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INTERNATIONAL HANDBOOK OF NEUROPSYCHOLOGICAL
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NEUROPSYCHOLOGICAL EXPLORATIONS OF MEMORY AND COGNITION:
Essays in Honor of Nelson Butters
Edited by Laird S. Cermak:
NEUROPSYCHOTHERAPY AND COMMUNITY INTEGRATION:
Brain Illness, Emotions, and Behavior
Tedd Judd
THE PRACTICE OF FORENSIC NEUROPSYCHOLOGY:
Meeting Challenges in the Courtroom
Edited by Robert J. McCaffrey, Arthur D. Williams, Jerid M. Fisher,
and Linda C. Laing
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Neuropsychotherapyand
Community Integration
Brain Illness, Emotions, and Behavior
Tedd Judd
Neuropsychological and Psychoeducational Services
Bellingham. Washington
Springer Science+Business Media, LLC
ISBN 978-1-4613-7162-5 ISBN 978-1-4615-4775-4 (eBook)
DOI 10.1007/978-1-4615-4775-4
© 1999 Springer Science+Business Media New York
Originally published by Kluwer Academic / Plenum Publishers in 1999
Softcover reprint of the hardcover 1s t edition 1999
10 9 8 7 6 5 4 3 2 1
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To all those poeple around the world, temporarily able-brained
and otherwise, who struggle to prevent brain illnesses
and to improve the lives of those living with injured brains.
Preface
The first time I walked onto a neurology ward during my graduate training I was
shocked (much as family members of people with brain illnesses probably are). I
had learned a great deal in class about aphasia, amnesia, agnosia, apraxia, and
other cognitive disorders, but I had not been prepared for the behavioral disorders
I was to encounter, for the severe physical disabilities, for the indignities of the
patient role. Bit by bit I overcame this shock. I learned to look people in the eye
who seemed to have more tubes than the New York subway system, people whose
faces had been scraped off the pavement and who were drooling, incontinent, and
severely dysarthric. I learned to see beyond what frightened and repulsed me to
the human beings within.
I wish I could say that I saw in each person a deep human soul yearning to
breathe free and to love, an essence, an intrinsic goodness, a wholeness; I did not.
Rather, it seems like each and every unique element of human behavior, one's
abilities, and one's desires can be destroyed by some brain lesion, while leaving a
uniquely human person behind. Not only are there losses, but behaviors emerge
at times that are not seen in people with intact brains but which still reveal a
human attempting to cope. I do feel that I saw and still see in each such person
something intrinsically human, but not the same thing in each. Some yearn, some
merely respond. Some emote, some cogitate indifferently. Some try, some do not.
I found that to be human is not one thing, but a collection of things that can be
distorted and partially destroyed in endless variations and combinations by the
dreaded diseases and injuries that can afflict our brains.
In my work, then, there is an element of faith-that I will find in each person
(however fractionated) a valuable being, worthy of respect, and deserving a place
in society. There is also an element of science-I need to find out who that person
is, what is that value, and, together with that person, what is that place in society.
Without the science I cannot find the person, the value, or the place in society
instead I will see my image of the person that I project; a false empathy. Without
vii
viii PREFACE
the faith, I risk losing my own humanity, not in a neurological sense but in a
moral one. It is my hope that I have been able to infuse this book with both that
faith and that science.
When I began training in clinical neuropsychology, the practice mostly in
volved diagnosis and disposition. I soon was disillusioned by a field in which the
common practice was to put the hopeful person through hours of difficult and
frustrating tests, only to give feedback which was, essentially, "Yes, you have
brain damage, alright, and of a particularly interesting kind. Good luck!" Lack
ing significant guidelines, I began my own feeble attempts to provide something
more substantial and useful. Over the years I found that my clinical intuitions
matched those of other neuropsychologists and findings emerging in the litera
ture, and that I had a systematic way of presenting these ideas that made them
accessible to the non-neuropsychologist. At that point, the idea for this book was
born.
Another formative experience in the development of this book was teaching
neuropsychology in Central America. Since 1986 I have intermittently taught
clinical neuropsychology most frequently in Nicaragua and in Costa Rica, where
neuropsychology was all but unknown. The need to make my field accessible and
practical in situations of great need and few resources honed my priorities and
my delivery. This led to the development particularly of much of the material in
Part 3. These experiences continue to open my eyes to the needless tragedies that
result from senseless warfare and violence, malnutrition, preventable diseases,
and economic injustice, and the devastating effects these outrages produce on
brains and on lives. The real motivation and drive behind this book, then, is to
take a few steps toward making the esoteric knowledge of neuropsychology prac
tical and useful for the many people in the world who have thus suffered from our
human failings.
Many worthy and relevant topics had to be excluded in choosing material
for this book. Application of these materials and approaches to children is worthy
of its own book and is not discussed here, although the alert clinician will find
many adaptable ideas (see Blosser & DePompei, 1989; Horton, 1994; Lehr, 1990;
Rosen & Gerring, 1986; Savage & Wolcott, 1994; Spanbock, 1992; Waaland &
Kreutzer, 1988; Ylvisaker, Feeney, & Mullins, 1995). Although many examples
in this book come from cross-cultural experience, explicit cross-cultural applica
tions are not discussed (see Cavallo & Saucedo, 1995; Dikengil, Jones, & Byrne,
1993; Galanti, 1991; Lynch & Hanson, 1992; Ramirez, 1991; D. W. Sue & Sue,
1990; Werner, 1990). Ways of coping with the use and abuse of alcohol and illicit
drugs in people with brain illnesses is also a specialized area which had to be
excluded (see Corrigan, 1995; Corrigan, Lamb-Hart, & Rust, 1995; Gualtieri,
1991; Langley, Lindsay, Lam, & Priddy, 1990; Miller, 1993).
In accordance with the desires of many groups advocating for the rights of
people with disabilities and the guidelines set forth by the American Psychologi-
PREFACE ix
cal Association (1994), people with brain illnesses will generally be referred to in
that manner to put the person first (rather than aphasics, amnesics, head injury
victims, survivors, brain-injured people, etc.). "Brain illness" here will be taken
to include traumatic brain injury. The terms "client" or "patient" will be used
when reference is to those social roles. I have alternated a generic "he" with a
generic "she" chapter by chapter.
The ideas presented in this book were a long time in development. I ben
efited substantially from discussions with Mary Pepping, Barry Willer, Jordi Pefia
Casanova, Federico Montero, Frida Madrigal, Fernando Acosta, Marcela Solano,
Marlene Koss, Idealda Lazo, Adriana Cortes, George Prigatano, and Bob Sbordone.
My students in Nicaragua, in Costa Rica, in Spain, and in the United States have
repeatedly challenged me to clarify, generalize, qualify, and demonstrate my ideas.
An anonymous woman who had had a traumatic brain injury coined the concept
of emotional rehabilitation, which was passed on to me by Lloyd Cripe. The able
staff at Good Samaritan Hospital in Puyallup, Washington provided a cognitive
rehabilitation framework, much feedback and discussion, and many opportunities
to tryout ideas. Among those many fine people to whom I am particularly grate
ful are Katie Mateer, McKay Sohlberg, Brian Baird, Jerry DeVore, Cindy Stoffel,
Fred Silver, Sarah Raskin, Kim Kerns, Dennis Williams, and Suzanne Geyer.
Elizabeth Sequeira "midwifed" the birth of the idea for this book at the first
Latin American Neuropsychology Congress in Buenos Aires in 1989. Together
we elaborated many of the fundamental concepts, such as the continuum of re
sponsibility, and refined their communication through workshop presentations.
Her tireless collaboration and support have been an inspiration, for which I am
continually appreciative. iEn solidaridad! Jill Winegardner shared with me and
later extended our teaching in Nicaragua. She coauthored earlier versions of por
tions of Part 3 as part of our Manual de Neuropsicolog£a Practica [Manual of
Practical Neuropsychology], and allowed me to use them here. Her sensitive col
laboration and high sense of purpose have helped to keep me focused, for which
I am most grateful. iLa lucha sigue!
My son, Robin Judd Walker, provided able editing, commentary, and pa
tience, and learned more about APA style than he ever wanted to know. He moni
tored my warning signs of cognitive fatigue and intervened with meals and with
physical exercise to prevent the onset of irritability. Muchas gracias, mijo. School
psychologist and counselor, my colleague, illustrator, coauthor, and life compan
ion, Roberta DeBoard, listened patiently; challenged and corrected my thinking;
tolerated late night writing sprees; read and edited the manuscript; never shrank
(to my knowledge) from offering criticism, correction, or coffee when I needed
it; and maintained faith in me and the project throughout it all. To her I offer my
heartfelt thanks and a well-deserved vacation. ~Sabes que? The errors and short-'
comings that all of these generous helpers failed to ferret out remain fully my
responsibility.
x PREFACE
The thousands of people with brain illnesses and their families and friends
with whom I have worked and shared triumphs, disappointments, and frustra
tions over the years have given me the experiences and inspiration that made this
book possible. It has been a privilege to have their trust and to have a glimpse into
their lives, so often at moments of great vulnerability.
TeddJudd
Contents
List of Tables ................................................................................................. xvii
List of Figures ........................ ...... ................... ...... .............................. ...... .... xxi
List of Cases .... ....... ...... ..... ............. ................. ...... .............................. ......... xxiii
Chapter 1
INTRODUCTION ......................................................................................... .
What Is Neuropsychotherapy? ....................................................................... 3
Who Is Neuropsychotherapy For? ................................................................. 6
What Problems Does Neuropsychotherapy Treat? ........................................ 6
Why Is Neuropsychotherapy Needed? .......................................................... 8
Who Is the Neuropsychotherapist? ................. ...... ..... ....... ..... ........................ 8
When Is Neuropsychotherapy Needed? ........................................................ 9
How Is Neuropsychotherapy Done? .............................................................. 14
Part I. THEORY ........................................................................................... 15
Chapter 2
NEUROLOGY AND NEUROPSYCHOLOGY ............................................ 17
Type of Illness . ... ....... ..... ......... ..... ............. ...... ..... ....... ..... ..... ............. ...... ...... 17
Time Course of Illness: The Continuum of Responsibility ........................... 17
Factors of Personality and Emotions following Brain Illness ....................... 26
Chapter 3
EDUCATION AND PSYCHOTHERAPY .................................................... 31
Education .. ....... ..... ............. ..... ..... ........... ........ ..... ....... ..... ....... ..... ...... ............. 31
Family Involvement ....................................................................................... 33
xi