The brain is a many-splendored organ, and neuropsychologists such as Melinda Kulish believe that brain function can be measured, in a good part, by behavior. If a normal person with an average IQ is shown a picture of a fork and identifies it as a spoon, for example, this is a sign that shows, without a doubt, that brain dysfunction is present. Other similar tests can measure language, reasoning, and judgment, as well as sensory and motor functions and reflexes.
While psychological tests such as the Rorschach ink blot, The Minnesota Multiphasic Personality Inventory, and Wechsler Intelligence Scales have long traditionally been used by psychologists who diagnose brain damage and disease, neuropsychologists take these assessment procedures a set further, making use of testing that provides a wealth of information about an individual’s unique pattern of skills and abilities.
But Kulish, a Boston neuropsychologist, admits that there is a lot of misunderstanding and ignorance about neuropsychology. “Many people aren’t even aware that neuropsychology exists,” said Kulish, a clinical neuropsychologist and instructor of psychology at Harvard Medical School. In her practice, she evaluates patients to determine if a medically- or biologically-based problem is contributing to a thinking, learning or behavior disorder. “I often see patients who need assessment after a sports injury, fall or car accident or other head injury.
Kulish admits she didn’t expect to become a neuropsychologist. While studying psychology in college, she very deliberately avoided taking the bio-psych requirement for her degree. “I felt totally disinterested and a little intimidated in the biological side of psychology. I believed it was wrong to reduce things to just biology; it felt reductionist and I thought it was missing the mark.” But when she took an independent study course in neuropsychology, the interdisciplinary nature of the field appealed to her immediately. “It bridged the gap between the science and the art of who people really are,” said Kulish.
Q. Can you give me an example of a recent patient ‘success story’?
A. A very high-powered businessman in his 40s was referred to me. He had multiple degrees from prestigious schools and was extremely successful, but recently was getting pushback from his company because he wasn’t able to do his job – he was becoming more and more disorganized and forgetful, even though his verbal skills remained intact. I did a battery of tests and, with other clinicians, concluded that he had a preliminary diagnosis of multiple sclerosis (MS). What was unique about him was that, unlike the typical case of MS, his motor skills were still initially OK, but his cognitive functioning was being affected. In the end, he got the support from his company that he needed.
Q. How many tests do you typically administer?
A. There is usually eight hours of face-to-face testing, split up into two sessions, adding up to over 20 tests. It is a huge amount of data to go through, but provides feedback to the family and patient when I generate a comprehensive report. A so-called learning disorder, for example, might be actually masking depression.
Q. Have you ever done any forensic neuropsychology?
A. I have done a little bit of court-related testing. Interfacing with the court system is a skill in and of itself. But with every evaluation that I conduct, I always think, ‘As with any written document, you never know, this could end up in court some day.’
Q. Would you ever do a neuropsych evaluation for yourself?
A. Definitely, especially as I get older. The nice thing about neuropsychology is that it can serve as a baseline for people to track how they are doing cognitively. You could compare results at age 65, and then again at age 75. But I would be a hard person to test because I am so familiar with all the evaluations.
Photo above of Kulish: Pat Greenhouse/Globe Staff