I read with interest Dr. Gerald Tramantano’s recent article entitled “Brain Injuries Effect More than Cognition” which was published in the June 20, 2004 issue of the New Jersey Law Journal. Dr. Tramantano’s experience nears my own. Many of my clients, like Dr. Tramantano’s patients, have coexisting emotional and psychiatric problems and difficulties along with the problems they are experiencing as a result of the traumatic brain injury. This is not surprising, given the recent wealth of reported literature dealing with issues such as coexisting depression and traumatic brain injury. See, for example, the recent article by Kreutzer, Seel and Gourley entitled “The Prevalence and Symptom Rates of Depression After Traumatic Brain Injury: A Comprehensive Examination” published in Brain Injury, 2001, Vol. 15, No. 7, 563-576 as well as the work of Hibbert and her colleagues.

Interestingly, it is the comorbid psychological and emotional problems which work to defeat the insurance industries claim that clients/patients are malingering when their neuropsychological evaluations get worse over time.

Their argument is that people with traumatic brain injury should get better over time and that consecutive neuropsychological evaluations should demonstrate improvement. Where, on the other hand, a patient does more poorly on a subsequent neuropsychological evaluation, that cannot be due to brain injury but is due to malingering and symptom magnification.

I have been very successful in depositions for getting defense experts to acknowledge that comorbid and even preexisting premorbid psychological and emotional problems play a large role in a patient not fully recovering from a traumatic brain injury.