Dr. Shmuel D. Mandelman holds a doctorate from Columbia University in educational and developmental psychology. He also spent five years conducting research at Yale University’s Child Study Center into the individual differences in cognitive ability. Afterwards, he went on to pursue a specialty in clinical neuropsychology and did his clinical training at Weill Cornell Medical Center, where he now conducts evaluations on both adults and children. In addition, he maintains a private consulting practice in Brooklyn, New York.
Q: There are so many mental health professionals with different areas of expertise and titles that for the layperson it’s very confusing. So before we begin, please describe what you do.
A: I’m in a bit of a funny position even within the field because I have a double PhD, in educational developmental psychology and clinical neuropsychology. I don’t do therapy; I only do assessments and consultation. A lot of what I end up doing is dealing with cases that are unclear diagnostically and need greater clarity, or else someone is in treatment and not making sufficient progress. I work on guiding the treating clinician. I see a lot messier things than most people simply because of the nature of the work I do.
Q: What do you mean by “messier”? Clinically? Diagnostically?
A: Both. We have kids coming in who have unclear psychiatric diagnoses. There are kids who are suffering and haven’t made gains in therapy. Some kids are just falling apart in yeshivah and no one is sure why. I don’t do marriage counseling per se, but in the last two days I’ve been called upon to give my opinion of someone’s readiness for marriage, given the psychological or emotional questions that have come up. I have a very good relationship with the treating clinicians. They send their patients to me for diagnostics and then they take care of the treatment. That’s why I prefaced my words by saying that my background and purview are a little different from most.
Q: In other words, psychiatrists and psychologists come to you for a second opinion?
A: They do, but sometimes the question is worded “We’re treating it like this; is that in fact what is going on? And if yes, is the treatment we’re using the most appropriate one?” Differential diagnosis and assessment is what I do on a very complex level. Neuropsychology is as much medically related as it is psychologically related, and psychiatrists aren’t bound by the same rules as we are. They can medicate and diagnose more loosely, but when they’re stuck they turn to neuropsychologists. No one is coming to me if something is clear-cut, only if it’s “messy.” If they’re coming to me there’s a level of ambiguity and complexity that needs further exploration.
Q: They only come if they have a question.
A: Correct. And besides referrals from psychologists and psychiatrists, when there are complex presentations and just a generalized decreased level of function, families will reach out as well and say, “We were referred to you because this is what we’re experiencing, and we need help in terms of figuring out what our next steps should be.”
Q: Would you agree that people are being misdiagnosed a lot? Mental health diagnoses seem to be much more fluid than for physical illnesses.
A: There is a level of misdiagnosis. The field in general has been moving towards a spectrum of diagnoses. Instead of using discrete categories, there is an increased appreciation for complexities. That has been helpful in many ways, because even if someone didn’t align perfectly with any particular criteria, it still allows you to capture much of it. At the same time, it leaves many more questions. Is it this or is it this? There are many times when you have to be honest and say, “These are the indicators towards this diagnosis, but at the same time a level of ambiguity remains.”