The neuropsychology field has enjoyed an explosion of literature in the past 20 years. Not only have journals focusing on cognitive assessment and neurocognitive functioning gained a strong foothold in the publishing world, but we have also been fortunate to see an influx of books. Our field has books focusing on the clinical practice of neuropsychology, the presentation of specific conditions, utility of neuropsychology in forensic settings, ethics in neuropsychology, and detailed discussions of very specific conditions (e.g., brain injury), just to name a few of the general areas of publication. With such a rich publication record, it is even that much more refreshing to see Military Neuropsychology arrive on the scene. Edited by two neuropsychologists with current and prior military service, this volume explicitly centers its attention on the special neuropsychology needs of the active duty military and veterans. Drs. Kennedy and Moore also effectively compiled an excellent mix of civilian neuropsychologists, military psychologists, and other clinicians intimately familiar with the distinctive needs of military men and women. In fact, many of the chapter authors not only have expertise in a particular area, but they have expanded their arena by applying their existing knowledge to the specialized field of military service members and veterans.
At the risk of sharing too much of the unique information contained in this excellent volume, I nonetheless wish to point out how each and every chapter of Military Neuropsychology offers an appropriately different perspective than that seen in general neuropsychology books.
In light of concern raised regarding blast concussion and blunt force traumas relating to military service in Iraq and Afghanistan, three specific chapters provide important information. Not only is blast concussion defined (Chapter 5), but the expected recovery to baseline for those injuries as well as mild traumatic brain injury is clearly presented. Guidelines for expected recovery based on initial symptoms are presented, emphasizing the importance of integrating evaluations of cognition, emotion, and effort. Chapter 6 presents information regarding standardized methods for evaluating acute symptoms following a concussion, as well as the common concurrent symptoms of sleep disruption, poor effort, emotional hyper-reactivity, and worsening of some symptoms with physical exertion. Interventions following an event to achieve a return to the battle field (Chapter 6) or to return to maximal medical improvement (Chapter 7) are presented. The levels and types of care needed for military members following more severe brain injuries are also explained in these chapters.
Typically, neuropsychologists are asked to evaluate an individual to reach general conclusions regarding status from a diagnostic and treatment perspective. Chapter 3 offers a slightly different perspective by discussing how neuropsychology is used to determine one's Fitness for Duty. Rather than determining if a condition is present, a Fitness for Duty evaluation asks if an individual is capable of performing the essential functions of his or her job. The manner in which the various levels of military oversight address the Fitness for Duty question based on that particular level's interest allows for the reader to better understand how neuropsychological data are used in a non-medical setting. As might be expected, such a situation might call for individuals performing suboptimally on neuropsychological tasks. The possibility of intentionally not performing at one's optimal potential has significant legal consequences in the military setting and can lead to formal proceedings. Objective evaluation of non-credible test performance relative to the military setting is presented in detail (Chapter 4), as is the possibility that an individual might attempt to deny cognitive difficulties (i.e., fake good).
Along similar lines as that seen in Fitness for Duty examinations, the potential deleterious effects of attention deficit disorder (ADD) on one's ability to perform effectively is addressed in Chapter 8. Traditional studies of ADD and learning disabilities focused on the need for accommodations to achieve optimal benefit from a situation. In contrast, within the military community, the needs of the organization supersede those of the individual, which is why evaluations for LD and ADD answer the question if an individual is suitable for military service. Similarly, acquired medical conditions, such as being HIV+ (Chapter 9), do not portend an automatic dismissal from military service. Instead, such conditions may result in cognitive compromise which would impair a service member's ability to effectively perform required duties.
In terms of ethical issues, Bush and Cuesta (Chapter 2) address some of the rarely discussed issues pertaining to confidentiality (as the mission is the patient, not the examinee), priority of ethical code (military rather than American Psychological Association), priority of legal code (military rather than civilian law), and retention of records (neuropsychology data belong to the military not the individual), just to name a few. Common in the themes addressed in this chapter is the issue that a neuropsychologist needs to be aware to whom an evaluation is being written and under which ethical code one reports.
Unique to few situations outside the military experience is the concept of the prisoner of war (POW) who is subsequently repatriated. Moore (Chapter 10) initially offers a fascinating study of former POWs from a simple perspective of tallying. Over 97% of all former United States POWs are from the Korean War or World War II. Consequently, clinicians are advised to recognize that, not only might psychological issues might be present, but so will many medical conditions seen in individuals who are in their middle 70s or older. In addition, the medical consequences of malnutrition and torture during internment on the potential for stroke and severe mental health conditions are outlined.
Neuropsychological functioning can be compromised by several different factors, some of which might be treatable. Within the military community, issues relating to sleep deprivation (Chapter 11) and psychiatric conditions (Chapter 12) must be taken into account. The deleterious effects of sleep loss in active duty service members are clearly discussed through the use of fascinating case reports in which safety was compromised and military decisions were undermined because of sleep loss. While posttraumatic stress disorder (PTSD) is well-discussed in other texts, Kennedy and Moore's book offers specific information regarding the cognitive sequelae seen in patients with PTSD. Unique to the combat experience is the constant need to make decisions in extreme and hostile environments (Chapter 13). The resulting operational demand-related cognitive decline is presented as a condition, as is information regarding the prediction of individuals who are more prone to this condition and treatments which might minimize its effect.
The timeliness of Military Neuropsychology cannot be overstated given the current climate in which our country is seeing a rise in returning service members from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) as well as a concurrent increase in hiring of psychologists through the Department of Defense and the Department of Veterans Affairs. The content of this volume covers many areas familiar to most practicing neuropsychologists, but does so by addressing the specific needs as applied to the military. The text truly transcends being “yet another book” by offering several chapters that are rarely discussed outside the military setting.
