Depression Makes Other TBI Problems Worse
The Defense Abuses Depression
The Defense will argue that Organic Brain Injury Doesn’t Get Worse, it Gets Better. We will argue that Depression makes other TBI problems worse.
- Any Decline is Related to Depression
- MMPI Abuse
Defense Abuses Depression, cont.
Unquestionably, the most frustrating and disturbing aspect of representing those with brain injuries, is dealing with the character assassination that the defense is using in virtually every case, to try to misdirect the focus from a truly disabling injury. While outright claims of “feigning and malingering” do occur, the more common, and unfortunately often more effective strategy is to label all deficits as a result of a “somatoform disorder”, stemming from a pre-injury depression. There exist serious problems with such a diagnosis, and legally it is flawed. Nonetheless, it is effectively being used to confuse and misdirect juries, with often devastating results. One which is depression makes other TBI problems worse.
The primary evidence of depression herein comes from the MMPI or MMPI-2, the standard psychological test that has been administered to determine an individual’s psychological profile, for generations. Even with uninjured people, the MMPI is a test of questionable value in real world applications. But its validity as a diagnostic tool with injured persons, is worse than minimal, it is contraindicated. It doesn’t touch on the fact that depression makes other TBI problems worse.
The MMPI is a test not “normed” against injured people. Someone who is going through the central nervous system stressors of a person adapting to a subtle brain injury, will over endorse items on the MMPI that relate to the very symptoms that he or she is having. Does that mean that emotional vulnerability is the reason for his problems? No, depression makes other TBI problems worse.
If the question asks you whether you are experiencing X,Y and Z physical and cognitive problems, and you are in fact experiencing such problems, then endorsement of those items, in no way reflects on your pre-injury emotional state.
As explained by Lloyd I. Cripe, Ph.D., in his chapter on the “Use of the MMPI with Mild Closed Head Injury” contained in The Evaluation and Treatment of Mild Traumatic Brain Injury, Lawrence Erlbaum, 1999, at page 296:
The basic reason that neurologic patients elevate on Scales 1, 2, 3, 7 and 8 is that the inventory is loaded with many items that can be endorsed by a neurologic patient because of their neurologic disorders and the resulting real-world problems rather than necessarily due to psychiatric disorders, “emotional factors,” or maladjustment. ….
In essence, a neurologic patient may elevate on these scales because of their neurologic symptoms, and not necessarily because of a psychiatric disorder. They may not be somatizing, depressed or maladjusted in any manner, although the profile can easily be misconstrued as indicating that there are “emotional factors” or a psychiatric disturbance on board.