Traumatic brain injury (TBI) is often described as the “signature injury” of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Neuropsychologists have made important contributions to our understanding of both the immediate and long-term impact of these injuries. Those working with active duty service members and veterans understand that care extends well beyond the assessment and treatment of these injuries alone. In addition to TBI, which afflicts approximately twenty percent of service members returning from duty in Iraq and Afghanistan (Vasterling and Dikmen, Reference Vasterling and Dikmen2012), our veterans face a host of other psychological threats that uniquely impact neuropsychological functioning including Posttraumatic Stress Disorder (PTSD), depression, chronic pain, and substance abuse. The comorbidity rates among TBI and psychological distress are high, further complicating the clinical presentation of our service members. In addition, diagnosis of a condition believed to be related to military service includes the potential for financial gain within the Department of Veterans Affairs (VA) System, creating additional challenges with assessment and treatment. Bush's Neuropsychological Practice with Veterans is the first comprehensive account of the challenges with evaluating and treating this rapidly expanding population of patients.
Neuropsychological research, assessment, and treatment of veterans largely revolve around the VA. Building upon the writings of clinicians and researchers who have extensive experience working with service members in the VA system, this book is framed with an understanding of the unique culture of treatment with active duty service members and veterans and the necessity for specialized delivery of methods and procedures. The book benefits from the first-hand knowledge of the inner-workings of military medicine combined with an informative, to-the-point writing style. Bush, in highlighting the information that his audience needs to know while avoiding surplus, has created a resource that any provider to active duty service members and veterans can turn to again and again to find information immediately helpful to their practice.
The book is divided into three parts: In Part I, Neuropsychological Assessment and Treatment, Bush presents the unique aspects of working with service members and veterans, practicing within the VA system, and how this relates to neuropsychological assessment and treatment. This is the heart of the advances made by this book. Bush does a brilliant job of not just explaining how neuropsychological assessment and treatment within the military is different from working with a civilian population, but in explaining why such differences matter and how they can permeate every aspect of the patient's presentation. He draws to light many issues commonly seen in neuropsychological assessment of active duty service members and veterans, including: the complex interplay between neurocognitive and psychiatric symptoms; the prevalence of malingering or unintentional exaggeration of problems and the importance of symptom validity testing; an appreciation that service members may report excessive cognitive complaints in the absence of objective medical explanations for their symptoms (i.e., “cogniform disorder”); the need for education as a key to treatment; and, the importance of collaboration between neuropsychologists and other professions and disciplines to treat complex conditions.
In Part II, Injuries, Illnesses, and Disorders, building on the unique facets of military medicine explored in Part I, Bush applies insights into the research, assessment, and treatment of healthcare issues confronting this patient population. Such issues include: TBI; improvised explosive device injuries; PTSD; cognitive impairment or dementia affecting aging veterans; human immunodeficiency virus and hepatitis; substance abuse; and those conditions that are unique to veterans such as hypoxia, decompression sickness, arterial gas embolism, gravity-induced loss of consciousness, Gulf War syndrome, Agent Orange, deployment combat and prisoner of war experience, heat effects, and cysticercosis. Bush provides a trove of information and insight into each injury, illness, or disorder, expertly accomplishing this within the perspective of military medicine. When viewed through this lens, the need for new directions in research, assessment, and treatment of what may be common conditions in the general population becomes paramount when caring for our service members and veterans.
Bush concludes the book by reviewing current neuropsychology training programs and discussing the development of further training programs in Part III, Training, Ethics, and Trends. Again, Bush draws on the policies and procedures of the VA system. His review and discussion of training programs is targeted in this regard. He reports where the VA system does, or can, excel and when it comes up short. Included in this discussion is an enlightened focus on the ethical guidelines of neuropsychological practice with active duty service members and veterans and how such guidelines differ from those applied to a general patient population. His final thoughts on new and future developments in neuropsychological practice with veterans are grounded in facts and expert analysis.
In Neuropsychological Practice with Veterans, Bush endeavors to compile a comprehensive account of how neuropsychological research, assessment, and treatment of veterans are impacted by military status. He succeeds brilliantly with this undertaking. The book addresses many neuropsychological issues prevalent in, but not exclusive to, military patients – most notably TBI from blast, PTSD, and symptom validity. Bear in mind what this book is and what it is not. It is not an in-depth review of TBI, PTSD, or symptom validity. There are dozens of wonderful books already in print on each of these topics. This book is written to allow the practitioner to address conditions from a different perspective and with an understanding of the unique elements of military medicine. The book provides an expert analysis on how the lessons that apply to the neuropsychological research, assessment, and treatment of a civilian population do not directly equate to a military population. It is critical for practitioners to acknowledge that these differences, however subtle, must be explored and understood in order to provide top-notch care for our military patients.
In summary, this is an essential text for those working with active duty service members and veterans, and is highly recommended to all those seeking new perspectives.
