Neuropsychology

The sample report is of a 28/82 coded profile, a Capitulated depression. A major and typical implication of this code is that the person has more or less given up. Commonly the patient is convinced his/her situation is hopeless whether or not the professionals see reason for hope. Thus, motivation needs to be immediately flagged as crucial to support. Collapsed scores on the Ego Strength scale further emphasize the effort this issue will need. A single scale interpretation would hypothesize that the elevation on 2-D is in response to the depth of losses felt as a consequence of the perceived damages that have occurred to one’s life, to losses of hope, gratification, and pleasure, and of the inability to be in charge of one’s will as one once was. The elevation on scale 8-Sc in part reflects the bewilderment as to the perceived drastic nature of these changes and - combined with scale 2-D - the helpless incapacitation of being unable to assert oneself. These are elevated by both cognitive impairments and breakdowns of sensory-motor functioning.

 

Although there is no codetype that is obtained by a majority of neuropsychological profiles, in my experience this Capitulated depression pattern has been the modal one in MMPI neuropsychological data. It still has a relatively high frequency with the MMPI-2, but at higher levels the latter norms considerably suppress the elevation on 8-Sc relative to the elevation of the same raw score on the original MMPI norms and also relative to the elevation on scale 7-Pd. This has the unfortunate effect of converting some profiles that would be 28/82 on the MMPI (with a more accurate clinical fit) to the 278 Internalized condemnation pattern on the MMPI-2. We have adjusted our cutoffs to help compensate for this.

 

Greene (2000) has a very thoughtful and thorough discussion of the question as to the impact of neurologic disorders on item responding on the MMPI-2. This includes the lack of success in developing specific neurologic "correction" scales; essentially the obtained scales do not differentiate neurologic patients from psychiatric patients even though they quite successfully differentiate both psychiatric and neurologic patients from normals. This raises interesting questions as to whether or in what ways the "psychopathology" of the neurologic patients is the same as or different from the "psychopathology" of psychiatric patients. Analyzing this in adaptational terms makes natural sense out of this effect. For example, when scale 2 is elevated, the person is struggling to adapt to anguishing or tragic personal losses and the consequent deprivations of positive rewards in life. Even though the nature of the losses and the personal histories as well as realistic future expectations may be distinctly different from one person to another, i.e., from brain dysfunction to the death of a loved one, etc., many of the physiologic depressive mechanisms that are initiated by suffering catastrophic losses are strongly overlapping. That is to say, depressions can be due to a wide range of adverse circumstances and life events, but many aspects of the struggle to adapt to personal misfortunes and tragic losses are common across depressed individuals.

 

In sum, the MMPI-2 enables us to better recognize the extent and qualities of the emotional impact of the person’s neurological status. This in turn is the guide to planning our responses to the emotional elements of the disorder.

 

The sample report analyzes a 28/82 coded profile, Capitulated depression. The Adaptation and Attachment supplement discusses this both as a lifelong developmental pattern and, in contrast, as a pattern associated with a brain trauma followed by limited post-injury recovery in the absence of a corresponding pre-injury symptomatic history (the sample is from a closed head injury case). These are two quite different courses with highly overlapping outcomes, both leading to a "giving up" depression or state of capitulation.

 

 

 

References

 

Greene, R. L. (1988). The MMPI: Use with specific populations. Philadelphia: Grune & Stratton, pp. 214-245).

 

Greene, R. L. (2000). The MMPI-2: An interpretive manual. Boston: Allyn & Bacon, pp. 276-283.