Psychology is the scientific study of the mind and the way that people behave. It looks into emotions, personality, intelligence, language and cognitions. Neuro psychology, is a specialization within psychology which studies the relationship between behaviour, emotions, various cognitive processes, and the brain. It examines how these cognitive processes are mapped on the brain, which parts and connections of the brain are specifically responsible for each of these. Some questions that neuropsychologists try to answer are: what is the process that goes into in the brain to be able to speak a language; to be able to do certain kinds of movement; to be able to learn and understand things; to be able to generate appropriate emotions.
Though neuropsychology has several career options, it is a relatively new field in India. However, in the medical field, the need to have a neuropsychologist is now felt by almost all neurosurgery and neurology departments. Neuropsychologists are also required in psychiatry departments, as it is now recognized that psychiatric disorders have a neuro psychiatric component.
What does a neuro psychologist do?
The neuropsychologist looks at the behaviour of a person and maps that behaviour to understand what might be happening in the brain. This can be done through keen observation of an individual’s behaviour: how the person talks; What is the tonal quality of the person’s voice; how the person is dressed; how does the person walk; how well is the person able to emotionally expressions themselves. A neuropsychologist would keenly examine these in order to understand which part of the brain might be affected. Though behaviour is one of the main tool for neuropsychologists, they also use objective tools, which are behavioural tests, or neuropsychological batteries of tests.
These batteries generally involve either paper-pencil tests or verbal tests which require oral/motor responses. These tests look at the other person’s responses to specific questions and tasks. Their responses are then analysed qualitatively and quantitatively to make certain conclusions about their brain functions. Often these analyses are done along with other objective measures such as MRI, EEG, PET scans and subjective measures like behaviour analysis, caregiver reports etc. These would then help them to understand the area of the brain affected and extent of damage or disease.
Why and when do we need these kinds of understandings or insights?
We primarily need these understanding and insights when we’re talking about people who are suffering from some kind of difficulty, which might lead to inputs to understand why these difficulties are happening.
Some common disorders that neuropsychologists are likely to see are various types of dementias, to diagnose the condition and see the extent of its effect. Repeating neuropsychology tests over time also helps us understand the trajectory of the disorder– effects of medication and therapy.
The other conditions that neuropsychologists commonly see are stroke and head injury. To understand which part of the brain is affected by the stroke or the injury and what is the extent of the damage; has it affected the personality of the person; the language skills of the person etc. This helps to understand how to better provide aid and care that the person needs. Often epilepsy patients are tested before surgery for surgeons to access which areas to target. And after surgery to see if things have improved post-surgery.
Neuropsychologists also see many patients who report various kinds of cognitive difficulty such as Attention Deficit Hyperactive Disorder (ADHD), Mild Cognitive Impairment (MCI), Parkinson’s Disorder.
It is well established that various psychiatric disorders such as Schizophrenia, Major Depressive Disorder, Obsessive Compulsive Disorder have neuropsychological components, that is, there is some affects these have on parts of the brain. Hence, in chronic conditions administering neuropsychological tests for such patients is recommended.
Neuropsychologists also work in paediatric settings. Applications for children are similar to the ones mention above. Neuropsychologists are often also involved in the care of other childhood conditions such as Learning Disorders, Autism Spectrum Disorders, Hydrocephalus etc., which show specific kinds of cognitive and IQ difficulties.
A neuropsychologists would typically do the testing and write a report. The results are then communicated to the other treating team members which could be the treating doctors, counsellors, psychologists who are working with the patient. Neuropsychologist also often communicate the test results to the patient and their families and counsel them regarding treatment options.
Neuropsychologists also work in non-clinical settings
One of the most common non-clinical setting would be a rehabilitation centre. Rehabilitation settings could be targeted at Addiction Rehabilitation or could be people who are recovering from a certain kind of disorder, could be old age homes, etc. Here the role of the neuropsychologist is also remedial. That is, to be able to help the clients improve in their specific condition.
Neuropsychologist have different ways to provide therapeutic work to their clients. This could be Cognitive Retraining or Neurofeedback Training. These are based on the understanding of ‘neuroplasticity’, the fact that the brain has the capacity to reorient itself through exposure. Cognitive retraining is a specialized form of rehabilitation where the clients are assisted in doing specific cognitive exercises, which help to strengthen cognitive abilities. For example, if a patient specifically has difficulty with learning and memory, in a cognitive retraining program, they would focus on learning and memory. The level of difficulty of such exercises is tailored to the patient and is progressively made more challenging as the patient improves. More training on a certain kind of exercise can help the brain to recover cognitive ability.
Neurofeedback training uses EEG information of the brainwaves and trains the brain to be able to correct its own waves and eventually lead to improvement in cognitive capacities. Specifically it is used in conditions like Traumatic Brain Injury (TBI) and stroke, now its applications are even recognised in Major Depressive Disorder and anxiety disorders.
The other areas that a neuro psychologist might work is also forensic psychology. Neuropsychologists are often called to the courts to give their understanding of a person, in case such a person who is on trial, have certain kind of cognitive and emotional difficulties. Here the neuropsychologist would conduct the tests and give the report to the court in the trials. For example these reports can be used to understand whether there is certain kinds of brain damage that could have caused these personality disorder and therefore made them susceptible to commit a crime.
Neuropsychologist also work in the field of academic research. Since it is a growing field there are many areas of research that are waiting to be explored. They sometimes provide inputs for policy making, for example, towards the kind of consequences a surgical intervention might have on a patient’s future.
What are the kinds of skills that a neuropsychologist needs?
Neuropsychology involves using behavioural tests and using their analysis in order to deduce something about the brain. Hence it is important that a neuropsychologist has good analytical skills. All psychologists require empathy skills, however, neuropsychologists mostly deal with people who are already struggling, hence, it’s important that a neuropsychologist is able to feel and understand that distress before they start to do the testing or when they give feedback.
Another aspect that is important is good communication skills. Because a neuropsychologist is constantly communicating the results, either to the clients or to the team that the client is working with, or to the court, judge, lawyers etc effective communication becomes imperative. Technical skills are equally important. Neuropsychologist often use MRI, EEG, PET scans, CT scans to corroborate their findings. They are therefore expected to update themselves with evolving technologies in the field.
What is required to become a neuropsychologist
In the United States ,to be a neuropsychologist, one requires a master's degree with specialization in neuro psychology. However, in India, there is no provision for a special master’s degree in Neuropsychology. So, one can study neuro psychology at the MPhil level. Most of the colleges that offer MPhil teach some component of Neuropsychology, but to be a fully certified clinical neuropsychologist, one requires a PhD degree in clinical neuropsychology. Becoming a neuropsychologist ,therefore, requires dedication and time, but provides a fulfilling and interesting career.
The article is written by Prof. (Dr.) Meenakshi Banerjee, Assistant Professor, Jindal School of Psychology & Counselling (JSPC).