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The Developmental Approach to Childhood Psychopathology
BOOK REVIEWS ings are followed by extensive commentaries, while others are brief. The heading “Aggression” (under “Drive Development”) is followed by meager comments; under the subheading “Ego Apparatuses” it is simply stated that “the intactness or defects of the ego apparatus are examined.” No attempt is made to guide the clinician’s assessment of a child’s aggressive drive development or the intactness of the critical underlying functional and somatic capacities of the child. These limitations are also indicated by the author’s treatment of the Developmental Profile as a whole. The Profile is frequently complimented for its value in guiding assessment and treatment, yet few clinicians actually use it because it is time-consuming and functions poorly as a data base. Nagera demonstrates the use of the Profile by giving a case example and examining features of the case related to each heading of the Developmental Profile. He persuades us that judicious application of the Profile will lead to greater clarity in understanding case material, but a method for making the Profile more accessible and practical for clinicians is not suggested. This would be a difficult book for medical students or other professional students approaching the basic concepts of psychoanalytic developmental psychopathology for the first time. It will be very useful for clinicians and advanced trainees who require a sourcebook for detailed discussion of a wide range of fundamental subjects but especially rewarding to the reader who turns to it one chapter at a time.
The Developmental Approach to Childhood Psychopathology. By Humberto Nagera, M.D. New York: Jason Aronson. 1981,507 pp., $30.00 Reviewed by J. Gerald Young, M.D.* This volume synthesizes the clinical approach of one of the leaders of child psychiatry and psychoanalysis. Divided into four parts, the text first discusses “general developmental considerations,” including fixation and regression, autoerotism, insight in children, and other topics. The second part examines ego apparatus and structure formation from a developmental perspective, and the third takes up topics of adolescent development. The final section of the book is a series of chapters elaborating on specific aspects of “the developmental approach in clinical practice.” Every individual chapter reflects the author’s interest and previous work, giving the sections a loose organization; nevertheless, each chapter embarks on a subject of definite clinical interest. This is a scholarly work, replete with detailed descriptions of the views of several clinicians on each subject. The great strength of the volume is its wealth of clinical examples which bring the abstract concepts to life. The contents of individual chapters vary from controversial (e.g., “Day-care Centers”), to clinically interesting and practical (e.g., “The Primary Caretaker System: A Method for Running Inpatient Units for Children”), to outdated (e.g., “Sleep Disturbances,” in which the most recent reference given is 1966). Nagera’s emphasis on developmental perspective provides the critical link across chapters. For example, to counter the occasional clinical mythologies built upon hypothesized infant thought processes, he uses Piagetian views of cognitive development, repeatedly focusing on evidence of a child‘s capabilities at given ages. The predominant conceptual framework for the book, however, is psychoanalytic theory, and its title would more properly include “psychoanalytic.” Nagera does not attempt to examine underlying developmental biology in any depth. The book does not contain new facts or emphasize the most recent research findings, but organizes clinical experience from many sources. Areas in which knowledge is limited receive little attention. For example, the book begins with a description of Anna Freud’s Developmental Profile, in which some head-
The Schizophrenic Child: A Primer for Parents and Professionals. By Sheila Cantor. Montreal, Quebec: Eden Press. 1982, 136 pp., $6.95 (paper) Reviewed by Aubrey Metcalf, M.D., and Beverly Metcalf,M.S.? How does one write a hopeful book for parents whose children suffer from a developmentally devastating condition of unknown etiology, uncertain diagnosis, and no cure? “With great hesitation,” most would reply. Sheila Cantor of the Department of Psychiatry and Pediatrics at the University of Manitoba Medical School and Medical Director of the Manitoba Schizophrenia Treatment and Research
t Ms. Metcalf is the learning specialist and Dr. Metcalf is the supervising Child Psychiatrist and Clinical Professor of Psychiatry on the Child and Adolescent Service, University of California, San Francisco.
* Dr. Young is Director of the Division of Child and Adolescent Psychiatry, Mount Sinai School of Medicine, Mount Sinai Hospital, New York. 209
The Developmental Approach to Childhood Psychopathology. By Humberto Nagera, M.D. New York: Jason Aronson. 1981,507 pp., $30.00 Reviewed by J. Gerald Young, M.D.* This volume synthesizes the clinical approach of one of the leaders of child psychiatry and psychoanalysis. Divided into four parts, the text first discusses “general developmental considerations,” including fixation and regression, autoerotism, insight in children, and other topics. The second part examines ego apparatus and structure formation from a developmental perspective, and the third takes up topics of adolescent development. The final section of the book is a series of chapters elaborating on specific aspects of “the developmental approach in clinical practice.” Every individual chapter reflects the author’s interest and previous work, giving the sections a loose organization; nevertheless, each chapter embarks on a subject of definite clinical interest. This is a scholarly work, replete with detailed descriptions of the views of several clinicians on each subject. The great strength of the volume is its wealth of clinical examples which bring the abstract concepts to life. The contents of individual chapters vary from controversial (e.g., “Day-care Centers”), to clinically interesting and practical (e.g., “The Primary Caretaker System: A Method for Running Inpatient Units for Children”), to outdated (e.g., “Sleep Disturbances,” in which the most recent reference given is 1966). Nagera’s emphasis on developmental perspective provides the critical link across chapters. For example, to counter the occasional clinical mythologies built upon hypothesized infant thought processes, he uses Piagetian views of cognitive development, repeatedly focusing on evidence of a child‘s capabilities at given ages. The predominant conceptual framework for the book, however, is psychoanalytic theory, and its title would more properly include “psychoanalytic.” Nagera does not attempt to examine underlying developmental biology in any depth. The book does not contain new facts or emphasize the most recent research findings, but organizes clinical experience from many sources. Areas in which knowledge is limited receive little attention. For example, the book begins with a description of Anna Freud’s Developmental Profile, in which some head-
The Schizophrenic Child: A Primer for Parents and Professionals. By Sheila Cantor. Montreal, Quebec: Eden Press. 1982, 136 pp., $6.95 (paper) Reviewed by Aubrey Metcalf, M.D., and Beverly Metcalf,M.S.? How does one write a hopeful book for parents whose children suffer from a developmentally devastating condition of unknown etiology, uncertain diagnosis, and no cure? “With great hesitation,” most would reply. Sheila Cantor of the Department of Psychiatry and Pediatrics at the University of Manitoba Medical School and Medical Director of the Manitoba Schizophrenia Treatment and Research
t Ms. Metcalf is the learning specialist and Dr. Metcalf is the supervising Child Psychiatrist and Clinical Professor of Psychiatry on the Child and Adolescent Service, University of California, San Francisco.
* Dr. Young is Director of the Division of Child and Adolescent Psychiatry, Mount Sinai School of Medicine, Mount Sinai Hospital, New York. 209