I have received the assessment reports on my more recent battery of tests regarding my persistent cognitive issues. To sum up the background, I have noted a significant cognitive loss since leaving my ex-husband. My sister has gone through a similar situation, dealing with her autonomic disorder and the emotional backlash of suppressing her own stress.
There are many issues I’ve experienced during my entire life, that have become more pronounced over the last few years. A simple example of this would be that I randomly smell what amounts to “phantom odors.” I also struggle with word finding issues, word deafness issues, and a more than normal amount of what can be easiest described as inadvertent “spoonerisms” These symptoms come and go randomly, sometimes happening often enough for a specialist to be concerned, while other times not happening at all. In fact, everything except the random phantom odors seems to be more prevalent if I am relaxed and/or in a state of some security, while if I am anxious or nervous or even over-tired, they are less likely to occur. This supports what the neurologist’s assessment prior to any organic testing, that it is an “attentional issue” (not that I have ADD/ADHD, but simply that something is taking attention away from my speech when I am more secure/safe. This, in all probability, is that my chronic pain takes up more of my attention when I feel safe, while when I am uncomfortable or nervous I am hyper-aware of my communication.
I went to a preliminary assessment, required by my insurance company (since it is the state-run plan for those of us dealing with issues making it difficult to work). I struggled with those results, not because it asserted that my cognitive impairment was from my combined depression and anxiety, but because it also diagnosed me with “somatic symptom disorder”. While in general, it is not meant to imply the sufferer is a “hypochondriac,” it does encourage someone with less experience, particularly less experience with chronic pain sufferers, to have an attitude that the particular patient is simply malingering. In my case, the young PsyD post-doc had two strikes against him in understanding my issues. And, during his interpretation of the preliminary tests, he also was conscious of being in a room with my sister, who I had introduced as a psychologist along to help me understand the results, if I had any struggles. He was very careful to be as objective as possible while she was there witnessing the interaction. However, when it was simply between him and I over the phone, he was aggressively defensive and somewhat condescending that I would question his interpretation of the results.
Those two strikes? The first was his lack of understanding (and experience) of how chronic pain interferes with and impacts cognitive function and awareness of one’s own body. As a post-doc, he was only recently graduated and licensed, which explains the lack of experience. On the specific test that was the main diagnostic tool for him (the MMPI), I received an “invalid” response. With my sister’s help, I supplied him with a peer-reviewed article discussing the fact that chronic pain sufferers consistently scored as invalid on that particular test (because the assumption is that if someone scores high on that portion of the test then they must be suggestive of “the possibility of numerous somatic complaints, selfishness, immaturity, and narcissism.” In other words, it’s all simply fake). He still insisted that there was no need for more in-depth testing, because he felt there would be no new information found. I reminded him that when he did his intake interview with me, I stated clearly that I was only being tested at his facility because my insurance insisted upon it.
The other strike was the overall population he works with at that facility. It works primarily with the “disadvantaged.” There are rampant assumptions and stereotypes that are prevalent in any support services aimed at this population. It isn’t just an assumption of those on welfare, because these services don’t just deal with the poor, but with anywhere from destitute poverty to middle-class addicts. Assuming everyone who comes through his door is inferior to his own level of intelligence and education is something he has not yet been forced to reassess. Usually, in the first 5-10 years of practice, a psychologist has learned not to make those assumptions, or have proven themselves unable to do so.
The report on the more in-depth testing? Between the fact that the organic tests (EEG and head MRI) proved to be normal for my “age and gender,” and the neuropsych testing shows that my cognitive issues are related primarily to my depression, anxiety and chronic pain (and therefore it is possible to regain my previous levels), I now have a solid base on which to discuss treatment plans with my general practitioner, my psychiatrist and my therapist. This is exactly the result I was hoping for – that I could get a solid foundation for future progress.
There is one more issue involved, but it is something that comes from other people. What the tests show is that I have significant loss of cognitive ability. However, the levels I am testing at are either perfectly average or slightly low average. Many people would say that still means that I am malingering, because there are millions of people who test at average or low average and they can live a productive work life.
But, that isn’t really comparing apples to apples here. It’s more like comparing apples with a carburator. The issue isn’t relative intelligence, it is relative functionality. If someone of average intelligence lost the same amount of cognitive function, they would also be struggling just like myself. It would simply put them closer to the lower end of the scale. I went from the higher end of the scale to the median. But my functionality is no better than someone who started at the median.
I still don’t have a concrete idea of how much and what kind of work I will need to do to recover what I have lost, nor do I have any idea if there is actually any way to estimate how long it will take to do it. All I can do is what I have been doing, taking it one day at a time and dealing with both the lows and the highs as they cycle through.