Neuro Testing Week, Pt. 2

tl;dr: Neuropsychological testing is fascinating and everyone should get to do it at least once

I love learning things. It’s quite possible that this the real reason I became a philosopher: the whole discipline is built around looking for answers to impossible questions, so you’re never done. Got an answer that satisfies you from one angle? Try looking at it from another angle! Or - even better - ask a group of philosophers what they think about your solution, because I promise there will be disagreement. (Other academics, please don’t use this tongue-in-cheek description to defund our field any further!)

I also love taking tests that don’t get graded, so I was feeling excited as well as nervous walking into my neuropsychological testing session last Monday. I’m two months into recovery from the second (and please let it be final) wave of meningoencephalitis, and my general health has finally stabilized. Time to establish a cognitive baseline, beeatches!

Before I go further, I need to warn you about something. The internet is annoyingly vague about what to expect from this sort of testing. All the medical sites claim that this is because there is such a wide range of possible tests that measure such a wide range of things, but it feels to me like maybe they don’t want people undergoing the testing to be able to study up and prep? In which case, too bad, because I’m about to blow the secret world of the tests I took WIDE OPEN.

First, here is the extremely high-tech lab where the testing took place:

(I cropped out the janky a/c unit at the very top of the window, but it added to the reassuring ‘no one is going to take your brain away from you here’ vibe of the room.)

Second, I was expecting to dive right into solving logic problems or whatever it was I was going to be doing, but it turned out that the first hour or so just involved talking to the neuropsychologist, ‘April’, who was conducting the tests. (Unless I have their explicit permission, I’m going to be using names from Grey’s Anatomy for any medical personnel I talk about in Brain Damage Diaries.) This part was easy - ‘April’ was lovely and somehow made giving her details about my medical history and comparisons between my former and current states not weird or awkward at all.

Then it was time for the formal tests. April jumped right in, giving me increasingly long sequences of numbers that I was meant to remember and repeat back to her. Then she did the same thing, but I had to repeat the numbers back to her in reverse order (UGH), and finally I had to repeat the sequence of numbers back to her but arrange them from lowest to highest. (The reverse random order one was the hardest for me - arranging them in ascending order at least gave me a structure to put them in when I was listening to her read the numbers off!)

We did several other memory tests as well: in one, April read a paragraph telling a short story that was packed with details like “on 6th St.” and “at 5:30pm” and “she took her coat off before she sat down”, and then I had to try to tell her as much as I could remember about the story. I could tell I’d forgotten a bunch from the first one, because April asked me if there was anything else I wanted to add in an “Are you really sure you’re done?” voice. I thought I’d nailed all the important details, but at a different stage of the test I had to answer true or false questions about the stories, and I realized I’d kind of left out the middle part of the story. Eh, everyone always skips the middle, right?

My favorite memory test, though, was when I got to hear the same 15 words a bunch of times in a row, and then was asked to repeat as many of them as I could. I’d figured out that if I grouped them in fives and assigned each word to a finger, I could easily tell if I was forgetting one, and wiggling the finger sometimes helped me remember the word. In fact, I concentrated so hard on getting them all down and in the right order that I can still rattle them all off. “Drum, bell, curtain, coffee, school…” (I’ll stop in case they always use the same list. Wouldn’t want anyone to go in knowing that the third line was “Turkey, nose, color, house, river”, after all!)

A number of the other tests involved drawing things. In one, April briefly showed me a sheet of paper with six figures on it and then asked me to draw the figures. Then I got to see the original figures again and try to draw them again, and once more, etc. I was a fan of these sorts of tests: anything that let me get a base and then build on it successively was way better than a one-off try.

For this particular game I gave the figures names, so I’d remember what they were and how to draw them. “Upside down house with slanted door!” “Geometric labia!” The trickiest figure for me to remember, not incidentally, was the one that was just a rectangle with another smaller rectangle in it. By the fourth time drawing them, I had settled for calling it “Boring nested rectangles” - much hard to remember than “Diamond/circle kissing”!

Overall, the aspect of the testing I found most fascinating was discovering which ones I was unexpectedly BAD at. I’ve had my whole life to figure out what sorts of games I’m good at, and now suddenly that list’s been shaken up! It’s like finding out that some of the flavors of ice cream you’ve always loved suddenly don’t taste good to you: you’ve got no idea ahead of time which flavors you’re not going to like any more, and so you have to re-try them all to find out.

Some of the tests I had some of the most trouble with involved ‘switching’ between things: numbers and letters, say, or colors and words. One test was essentially ‘connect the dots’ (although, sadly, the result was not a picture). I didn’t struggle connecting the numbers in ascending order, or the letters in alphabetical order. But the version where I had to switch between from 1 to A to 2 to B to 3 to C? My brain suddenly felt like it was wading through mud.

The most surprising of these “Wow - I’m suddenly bad at this!” discoveries for me involved an extremely simple test: April showed me a sheet of paper filled with rows of squares colored red, green, or blue. All I had to do was tell her what the colors were, from left to right. Easy-peasy, right? As it turned out, it was bizarrely difficult! I could see the colors, and I knew exactly which color was which. But I sounded like the Action Hero in a movie fighting against the effects of the supervillain’s truth serum and gasping out: “I’ll … never … tell!” Or in my case, “Red … red … GREEN … blue!”

It was one of the strangest sensations I’ve ever had. Especially since the next stage of the test was to look at a sheet of paper that had the words for the colors printed on it in black ink and read them off, and that was cake! The third stage of the test was to look at words (‘red’, ‘green’, blue’) that were printed in colored ink not of that color (so the word ‘red’ was actually green, etc.). This was not actually that much harder for me than saying the color of the squares out loud in the first stage - which is to say it was HARD. In the final stage, April showed me the same sheet with the colored words from the third stage, only this time there was also a black box around some of the words. When I got to a box, I was supposed to just read the word itself, not name the color of the ink the word was printed in. This was alternating agony and bliss: it was so much work trying to say ‘green’ for the green word that spelled ‘red’, and such a freaking relief to get to the words in the box and just have to read them!

The final test I took involved several configurations of a Tower of Hanoi game. I’d mentioned to April during our interview that I was having difficulty figuring out and/or completing the steps that needed to happen in the right order to reach an end goal - like successfully completing a recipe. (Pumpkin bread, my damaged brain and I will master you yet!) So she brought my balrog to me in the shape of three wooden pegs and variously sized disks.

Now, this is one of the world’s most ubiquitous puzzles for children, and I have not only been a child myself - I have also had a child and gone through all the games all over again. I know how the Tower of Hanoi works! (Basically, you can only put smaller discs on top of larger ones, you can only move one disc at a time, and the goal is to create a stack from largest to smallest on the far right peg.)

So I crushed it? Yes? Or at least got stuck on a vaguely respectable level of the six levels April had me try?

Ha! The ONLY level I solved was the very first one, where she put down two disks, and I just had to put the one on top of the other. I couldn’t figure out even the second level, where there were only three discs and three pegs. I asked April about the directions again to make sure, because the task seemed impossible: “You really can’t put a larger one on a smaller one? Like, ever??” For a moment on the third level, I saw what I needed to do, but as soon as I tried to do it, the flash of insight went away.

It was so frustrating! I “know” how to do it - there’s a trick where you move the smaller pieces around in sequences to free up the larger ones, etc., and it’s basically a variation of that same strategy no matter how many discs you have. I could even tell April about the strategy! I just couldn’t actually implement it. I would stare those stupid discs down like I was trying to move them with my mind, but ultimately I would just sit there until my time ran out. (Note: if you can’t even figure out how to TRY to do something, that’s a lot of time for you and your neuropsych evaluator to sit in awkward silence on the off chance that inspiration suddenly strikes.)

On that triumphant note, my testing was over, four hours after it started, and I wandered back home, in that strange state of tired-and-wired I associate with a really long day of teaching.

Next week - testing results! Make your wagers now as to what they’ll reveal, and then next week you can feel the pleasure of vindication…or at least nod your head wisely and think, “I did suspect that!”

(Also, if you think I didn’t immediately look up Tower of Hanoi games online the next day and start relearning how to play it, well, then you will be very surprised by a lot of what happens here in the Brain Damage Diaries.)