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The Mind of the Child Who Is Said to Be Sick.
248
BOOK REVIEWS
students receiving their education in the same setting as their nonhandicapped peers. Through theoretical formulations as well as with very pragmatic suggestions and plans of action, the authors of the book in one voice plead for the full integration of all severely handicapped students in our public schools. The book may be rough going for the typical child psychiatrist whose only connection with a school might be as a part-time consultant. The writing, although frequently containing important information, is often dry, and because of multiple authorship, there is some repetition and overlap among the chapters. After a review of the history of education for the handicapped, there is discussion about the concept of the least restrictive environment and the nitty-gritty of the implementation of PL-94-142. This includes four case histories of how families fought for their rights under this law. Four chapters are devoted to the means by which schools can make the transition to more integrated services. The role of educators and community agencies is discussed and there are even practical suggestions for helping nonhandicapped students adjust. Five chapters are devoted to very concrete means by which interactions can be facilitated once handicapped students are brought into the school. Of particular interest are ways in which students themselves, as young as fifth and sixth graders, can serve as teachers and role models for the handicapped. Specific school programs concerned with education as well as leisure time activities are presented, and there are many charts, checklists and diagrams. Two final chapters are devoted to the state and federal perspectives on integrating the severely handicapped and the many ramifications of PL-94-142. This volume will probably be most valuable to ed· ucators rather than psychiatrists. However, for those clinicians working in school systems with normal and/ or handicapped children, the book provides much background information and ought to raise their level of sensitivity. It is packed with information and not easy reading, however, and will serve better as a text to be consulted as needed. Ample bibliographies after each chapter guide the interested reader to further information.
The Mind of the Child Who Is Said to Be Sick. Edited by Donna R. Copeland, Betty Pfefferbaum and Allison J. Stovall. Springfield, Ill.: Charles C Thomas, 1983, 299 pp., $39.75. Reviewed by Andrea S. Hay, L.C.S. W. * This book comprises the proceedings of the Seventh Mental Health Conference sponsored by the Depart• Ms. Hay is a social worker at the Clinical Center, National Institutes of Health, Bethesda, Maryland.
ment of Pediatrics at the University of Texas M. D. Anderson Hospital and Tumor Institute in Houston, held in March 1982. The 39 contributors include a variety of mental health professionals, pediatric practitioners, patients, and their families. While most of the selections are illustrative of the child with cancer, the content may be readily generalized to children with any chronic illness. The book is divided into six sections: the child's perception of being sick, the effects of chronic illness, development and education of the ill child, the impact and role of the family, societal aspects, and various types of supportive therapy. This book fails to escape the shortcomings of its structure. Because the selections are numerous and brief, many of them verge on the superficial. The content is valid and accurate, but rarely new or provocative to anyone experienced in the area of mental health practice in a pediatric setting. Much of the information is descriptive and is not developed beyond that point. Despite this major flaw, there is useful material in this book. Section V, entitled "Society and the Child," presents many of the vital issues of the day in chapters on the ethical rights of the child, legal rights of the child, and informed consent. Models are developed to consider the child's participation in decision making about his own treatment, models which include the role of the physician as a trained professional and as society's agent, as well as the role of the child, parents, and society. In like manner, the legal rights of children are categorized into four separate types illustrating the concepts of entitlements, liberties, legal powers, and legal immunities/legal liabilities. The author then goes on to comment upon the inherent conflicts and tension in the philosophical underpinnings of the movement for children's rights. These models and typologies form the background for the debate over informed consent where further complex issues arise. Two such issues are the independence that children may have in decision making while remaining dependent on their parents, and the balance between protection and honesty in discussing his disease with the child. While no simple solutions are presented in these chapters, information is presented in a framework which the reader can use as he struggles with these issues in his own practice. Section VI details a variety of supportive therapies whose goals are to provide emotional support and guidance to the ill child and his family. The chapter on hypnotherapy is quite exciting, as it focuses on areas appropriate for hypnotic intervention and specific techniques appropriate to specific problems or the specific emotional needs of children. The selection on support groups for children younger than age 12 is also very enlightening, as the author explains the
BOOK REVIEWS
evolution of a group which she led and offers specific guidelines for the implementation of such groups. She neatly accounts for the impact of the child's developmental stage on his functioning in the group. Section III, which focuses on the interface between the child and school, is also thought provoking. The importance of reintegrating the child into his usual school setting is well known and accepted, but the process by which it can be accomplished is not always thoroughly considered. What problems can be expected as the child returns to school? One selection presents the issues from the perspectives of the child, parent, teacher, and classroom peer. The impact of the child's developmental stage and the type of cancer treatment as contributing factors to the child's adjustment are also delineated. Other chapters in this section deal with the potential developmental delays resulting directly from treatment involving the central nervous system and the reliability of various testing instruments to measure central nervous system status. The author of this latter section also defines and presents what he considers to be a reasonable neuropsychological battery for children that can be used for pediatric assessment. A selection in Section II, entitled "Effects of Chronic Illness on Cognitive Development," applies a developmental phenomenological focus to the man-
249
agement of and intervention with children who have a chronic illness. This framework is a most useful one in planning all our interactions with the child, as it reminds us to consider the different experiences of each child, the importance of his or her cognitive development, the role of fantasy, the integrity of his or her self-image, and the child's use of defense mechanisms. I think it is always a privilege to hear patients' or family members' reflections on the stressful experiences they have encountered and conquered. The selections in this book are no exception as the children discuss their behavior at home and in the hospital, the impact of school, and their ideas about coping. An additional selection describes the grieving process as it is lived by parents whose daughter had died a year earlier. In summary, this book would be useful primarily to students in any of the mental health professions or to mental health practitioners unfamiliar with practice in a pediatric medical setting. Most of the selections present only elementary information and leave the reader feeling disappointed and frustrated because he or she has not learned anything new, startling, or profound. To the experienced clinician working daily with children with chronic illness, this book is simply not worth the cost in time or money.
BOOKS RECEIVED The Journal hereby acknowledges with appreciation the receipt of these books from their publishers. Those of special interest to our readers will be reviewed in the Journal as space permits. Handbook of Psychiatric Consultation With Children and Youth. Edited by Norman R. Bernstein, M.D. and James Sussex, M.D. Chicago: Spectrum Publications, 1984,400 pp., no price given. Bereavement Reactions, Consequences, and Care. Edited by Marian Osterweis, Frederic Solomon and Morris Green. Washington, D.C.: National Academy of Sciences, 1984,312 pp., no price given. Seven Advances in Clinical Child Psychology. Edited by Benjamin B. Lahey and Alan E. Kazdin. New York: Plenum Press, 1984,352 pp. no price given. Handbook of Psychological Assessment. by Gary GrothMarnat. New York: Van Nostrand Reinhold, 1984, 478 pp., $38.50 The Development of Memory in Children. by Robert Kail. New York: W. H. Freeman, 1984, 212 pp., $17.95 The Family's Construction of Reality. by David Reiss. Cambridge, Mass.: Harvard University Press, 1981, 424 pp., no price given.
Severe Personality Disorders. By Otto F. Kernberg, M.D. New Haven, Conn.: Yale University Press, 1984, 381 pp., $35.00. Adolescence and Developmental Breakdown. By Moses Laufer and M. Egle Laufer. New Haven, Conn.: Yale University Press, 1984,225 pp., $20.00. Single Case Experimental Designs: Strategies for Studying Behavior Change. By David H. Barlow and Michael Hersen, New York, New York: Pergamon, 1984, 419 pp., hardcover $39.50 and softcover $17.50. Gender and the Life Course. Edited by Alice S. Rossi. New York, New York: Aldine, 1985,368 pp., hardcover $34.95 and softcover $14.95. Handbook of Psychological Assessment. Edited by Gerald Goldstein, New York, New York: Pergamon, 1984,471 pp., hardcover $60.00. Research Methods in Clinical Psychology. Edited by Allan S. Bellack and Michael Hersen. New York: Pergamon, 1984,417 pp., hardcover $45.00 and softcover $19.50. Analyzing Children's Play Dialogues. Edited by Frank Kessel and Artin Goncu. San Franscico: JosseyBass, 1984, 94 pp., $8.95.
BOOK REVIEWS
students receiving their education in the same setting as their nonhandicapped peers. Through theoretical formulations as well as with very pragmatic suggestions and plans of action, the authors of the book in one voice plead for the full integration of all severely handicapped students in our public schools. The book may be rough going for the typical child psychiatrist whose only connection with a school might be as a part-time consultant. The writing, although frequently containing important information, is often dry, and because of multiple authorship, there is some repetition and overlap among the chapters. After a review of the history of education for the handicapped, there is discussion about the concept of the least restrictive environment and the nitty-gritty of the implementation of PL-94-142. This includes four case histories of how families fought for their rights under this law. Four chapters are devoted to the means by which schools can make the transition to more integrated services. The role of educators and community agencies is discussed and there are even practical suggestions for helping nonhandicapped students adjust. Five chapters are devoted to very concrete means by which interactions can be facilitated once handicapped students are brought into the school. Of particular interest are ways in which students themselves, as young as fifth and sixth graders, can serve as teachers and role models for the handicapped. Specific school programs concerned with education as well as leisure time activities are presented, and there are many charts, checklists and diagrams. Two final chapters are devoted to the state and federal perspectives on integrating the severely handicapped and the many ramifications of PL-94-142. This volume will probably be most valuable to ed· ucators rather than psychiatrists. However, for those clinicians working in school systems with normal and/ or handicapped children, the book provides much background information and ought to raise their level of sensitivity. It is packed with information and not easy reading, however, and will serve better as a text to be consulted as needed. Ample bibliographies after each chapter guide the interested reader to further information.
The Mind of the Child Who Is Said to Be Sick. Edited by Donna R. Copeland, Betty Pfefferbaum and Allison J. Stovall. Springfield, Ill.: Charles C Thomas, 1983, 299 pp., $39.75. Reviewed by Andrea S. Hay, L.C.S. W. * This book comprises the proceedings of the Seventh Mental Health Conference sponsored by the Depart• Ms. Hay is a social worker at the Clinical Center, National Institutes of Health, Bethesda, Maryland.
ment of Pediatrics at the University of Texas M. D. Anderson Hospital and Tumor Institute in Houston, held in March 1982. The 39 contributors include a variety of mental health professionals, pediatric practitioners, patients, and their families. While most of the selections are illustrative of the child with cancer, the content may be readily generalized to children with any chronic illness. The book is divided into six sections: the child's perception of being sick, the effects of chronic illness, development and education of the ill child, the impact and role of the family, societal aspects, and various types of supportive therapy. This book fails to escape the shortcomings of its structure. Because the selections are numerous and brief, many of them verge on the superficial. The content is valid and accurate, but rarely new or provocative to anyone experienced in the area of mental health practice in a pediatric setting. Much of the information is descriptive and is not developed beyond that point. Despite this major flaw, there is useful material in this book. Section V, entitled "Society and the Child," presents many of the vital issues of the day in chapters on the ethical rights of the child, legal rights of the child, and informed consent. Models are developed to consider the child's participation in decision making about his own treatment, models which include the role of the physician as a trained professional and as society's agent, as well as the role of the child, parents, and society. In like manner, the legal rights of children are categorized into four separate types illustrating the concepts of entitlements, liberties, legal powers, and legal immunities/legal liabilities. The author then goes on to comment upon the inherent conflicts and tension in the philosophical underpinnings of the movement for children's rights. These models and typologies form the background for the debate over informed consent where further complex issues arise. Two such issues are the independence that children may have in decision making while remaining dependent on their parents, and the balance between protection and honesty in discussing his disease with the child. While no simple solutions are presented in these chapters, information is presented in a framework which the reader can use as he struggles with these issues in his own practice. Section VI details a variety of supportive therapies whose goals are to provide emotional support and guidance to the ill child and his family. The chapter on hypnotherapy is quite exciting, as it focuses on areas appropriate for hypnotic intervention and specific techniques appropriate to specific problems or the specific emotional needs of children. The selection on support groups for children younger than age 12 is also very enlightening, as the author explains the
BOOK REVIEWS
evolution of a group which she led and offers specific guidelines for the implementation of such groups. She neatly accounts for the impact of the child's developmental stage on his functioning in the group. Section III, which focuses on the interface between the child and school, is also thought provoking. The importance of reintegrating the child into his usual school setting is well known and accepted, but the process by which it can be accomplished is not always thoroughly considered. What problems can be expected as the child returns to school? One selection presents the issues from the perspectives of the child, parent, teacher, and classroom peer. The impact of the child's developmental stage and the type of cancer treatment as contributing factors to the child's adjustment are also delineated. Other chapters in this section deal with the potential developmental delays resulting directly from treatment involving the central nervous system and the reliability of various testing instruments to measure central nervous system status. The author of this latter section also defines and presents what he considers to be a reasonable neuropsychological battery for children that can be used for pediatric assessment. A selection in Section II, entitled "Effects of Chronic Illness on Cognitive Development," applies a developmental phenomenological focus to the man-
249
agement of and intervention with children who have a chronic illness. This framework is a most useful one in planning all our interactions with the child, as it reminds us to consider the different experiences of each child, the importance of his or her cognitive development, the role of fantasy, the integrity of his or her self-image, and the child's use of defense mechanisms. I think it is always a privilege to hear patients' or family members' reflections on the stressful experiences they have encountered and conquered. The selections in this book are no exception as the children discuss their behavior at home and in the hospital, the impact of school, and their ideas about coping. An additional selection describes the grieving process as it is lived by parents whose daughter had died a year earlier. In summary, this book would be useful primarily to students in any of the mental health professions or to mental health practitioners unfamiliar with practice in a pediatric medical setting. Most of the selections present only elementary information and leave the reader feeling disappointed and frustrated because he or she has not learned anything new, startling, or profound. To the experienced clinician working daily with children with chronic illness, this book is simply not worth the cost in time or money.
BOOKS RECEIVED The Journal hereby acknowledges with appreciation the receipt of these books from their publishers. Those of special interest to our readers will be reviewed in the Journal as space permits. Handbook of Psychiatric Consultation With Children and Youth. Edited by Norman R. Bernstein, M.D. and James Sussex, M.D. Chicago: Spectrum Publications, 1984,400 pp., no price given. Bereavement Reactions, Consequences, and Care. Edited by Marian Osterweis, Frederic Solomon and Morris Green. Washington, D.C.: National Academy of Sciences, 1984,312 pp., no price given. Seven Advances in Clinical Child Psychology. Edited by Benjamin B. Lahey and Alan E. Kazdin. New York: Plenum Press, 1984,352 pp. no price given. Handbook of Psychological Assessment. by Gary GrothMarnat. New York: Van Nostrand Reinhold, 1984, 478 pp., $38.50 The Development of Memory in Children. by Robert Kail. New York: W. H. Freeman, 1984, 212 pp., $17.95 The Family's Construction of Reality. by David Reiss. Cambridge, Mass.: Harvard University Press, 1981, 424 pp., no price given.
Severe Personality Disorders. By Otto F. Kernberg, M.D. New Haven, Conn.: Yale University Press, 1984, 381 pp., $35.00. Adolescence and Developmental Breakdown. By Moses Laufer and M. Egle Laufer. New Haven, Conn.: Yale University Press, 1984,225 pp., $20.00. Single Case Experimental Designs: Strategies for Studying Behavior Change. By David H. Barlow and Michael Hersen, New York, New York: Pergamon, 1984, 419 pp., hardcover $39.50 and softcover $17.50. Gender and the Life Course. Edited by Alice S. Rossi. New York, New York: Aldine, 1985,368 pp., hardcover $34.95 and softcover $14.95. Handbook of Psychological Assessment. Edited by Gerald Goldstein, New York, New York: Pergamon, 1984,471 pp., hardcover $60.00. Research Methods in Clinical Psychology. Edited by Allan S. Bellack and Michael Hersen. New York: Pergamon, 1984,417 pp., hardcover $45.00 and softcover $19.50. Analyzing Children's Play Dialogues. Edited by Frank Kessel and Artin Goncu. San Franscico: JosseyBass, 1984, 94 pp., $8.95.