Download Interview with

Interview with
JAMES S. WALKER, Ph.D.
Vanderbilt Forensic Psychiatry
Dr. Jim Walker is a neuropsychologist in Vanderbilt’s Forensic Psychiatry Program, a program that specializes in
performing mental evaluations with patients who are involved in civil or criminal litigation. He is an assistant
professor in the psychiatry and neurology departments. He is also a consultant for Social Security’s disability
insurance program.
Dr. Walker received his Ph.D. degree in clinical psychology from the University of Louisville. Prior to joining
Vanderbilt, he served as the neuropsychologist of a brain injury rehabilitation hospital and was in private practice.
Dr. Walker has special interest in working with head-injured patients, patients with seizures, and patients
suspected of faking mental problems.
1. What is neuropsychology? How does it compare with psychology? With psychiatry?
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Neuropsychology is a specialty within psychology. Neuropsychologists perform tests to determine the seriousness of a
person’s thinking and memory problems in patients with brain damage (like head injury and Alzheimer’s disease) or serious
mental illnesses (like major depression and schizophrenia).
Neuropsychologists usually also do what other clinical psychologists do: psychotherapy, personality testing, and intelligence
testing.
Psychiatrists are physicians who specialize in assessing and treating serious mental disorders, usually with medication
therapy.
2. What can neuropsychological evaluations reveal about an injured worker?
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Most importantly, neuropsychological evaluations will reveal how a worker is presenting himself or herself. It will provide
information about whether the patient tends to magnify problems, or cover them up. It will usually identify persons who are
faking a brain injury or serious mental disorder.
For persons with genuine brain injuries, the neuropsychological evaluation will show what kind of thinking and memory
problems a persons has, and how serious they are.
The neuropsychological evaluation will identify areas for rehabilitation and treatment, in order to return a person to normal
function.
3. What are the benefits of sending the medical records of injured workers currently receiving psychiatric treatment
for a review?
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Review of records allows a check on the diagnosis of the employee. Nothing is worse than providing and paying for treatment
for the wrong disorder, or continuing to provide treatment if the patient is noncompliant.
A review will indicate if the current treatment meets the standard of care accepted in our profession. Many times I also ask
for a simultaneous review by a forensic psychiatrist as well.
Most psychiatrists and psychologists are very competent, but it is normal to “get stuck” in treating a patient. A review can
often identify ways to enhance treatment.
A review can also provide information to predict the length and intensity of necessary treatment.
4. Can you address and discuss the issues of secondary gains for injured workers?
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To mental health professionals, secondary gain and faking are two different things. Fakers consciously manufacture or
exaggerate their problems to receive benefits. Employees with secondary gain just like to be sick, many times because they
like others to take care of them and show them sympathy and support.
Many times treatment personnel get “roped in” by a patient’s personality, and get enlisted to provide support and caring
when the patient really needs to move out of their psychological dependency on others.
A review can identify whether personality factors, like dependency, narcissism, or a hysterical style, are affecting a person’s
treatment progress
5. Many head injuries are seemingly minor, but the injured worker receives a diagnosis of post concussion syndrome.
How do you know if the symptoms are real? What can be expected after a brain injury?
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It is critical to refer employees who are suspected of having concussions to neurologists or neuropsychologists who regularly
work with head- injured patients.
There is a classification system for head injuries that will allow a good prediction to be made about how serious any
symptoms are likely to be.
A review of the records will usually determine whether the head injury is the type likely to cause serious problems. Many
mistakes are made because a clinician bases the diagnosis on what the patient says, rather than on what really happened.