Three further clinical faces of childhood

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0277-9536/82/lI I 169-08SO3.0010 Copyright 0 1982Pergamon Press Ltd

SC;. Med. Vol. 16. pp. I 169 to I 176. 1982

Printed in Great Britain

BOOK

REVIEWS

Coping and Defending: Processes of Self-Environment Organization, by NORMA HAAN. Academic Press. New York. 1977. 342 pp., 817.50

Norma Haan’s book Coping and Defending is a bold attempt to initiate a novel view of ego functioning as process by fusing aspects of Freud’s theory of the ego’s defenses with Piaget’s stages of cognitive development. Haan presents “a refurbished psychoanalytic theory” dexterously merged to “a Piagetian theory that (is) extended (via the tenets of George Herbert Mead’s symbolic interactionism) to become more a psychology of ecosystems and less one of entities” (p. 244: words in parentheses mine). The fruit of this marriage is what Haan christens a “personal-social psychology of meaning” (p. 244). She is concerned primarily with “how people make something out of what situations make of them” (p. ix). In order to deal with this book on its own terms one must share or appreciate its personological (or clinical, phenomenological) orientation. A further requirement might be for the reader to have at least some capacity to tolerate ambiguity. Haan uses many theoretically important core concepts without adequately defining them historically or ideosyncratically (terms such as process, structure, assimilatory mode and ego). This omission creates, at worst, some theoretical confusion. Unfortunately. however. Haan’s writing itself begets a generalized confusion. Many of her sentences are unbearably long (40-50 words). They meander from idea to idea until the point is effectively lost. Haan’s writing is both complicated and murky. The dedicated and interested reader might well develop an agitated exhaustion. Haan surprisingly generates a number of neologisms, which if one is well versed in the jargon of personality psychology one should be able to puzzle out. I was particularly enchanted with “extraintrapsychic”. “privatistic” and “thingness”. Yet. despite these minor editorial problems, the many flashes of insight that accompany reading Haan make the journey through her morass of high-sounding vocabulary worth every step. In sum, for the reader with just the right level of patience and panache, Haan’s book has much to offer. Haan is at once penetrating and intellectually honest. She states outright that her approach may not be ‘*the best one or even necessarily complete in itself. The more important and durable idea is that personality is processes” (p. 243). I couldn’t agree more. Haan sees personality (specifically “ego”) as not structure and hence not static. but rather as a dynamic process characterized by continual adjustment and adaptation to the environment. Haan goes on to state that through assimilation and accomodation (a 18 Piaget), the ego processes develop. There are ten ego processes in Haan’s scheme. Two examples are selective awareness and sensitivity. Each has three modes: coping, defending and fragmentation. The coping mode involves the individual’s dealings with environmental events, (that is, his use to the fullest extent possible of logic. wisdom, productivity and civihty). Coping, then, is considered positive functioning in that it is flexible and reality-oriented. But the individual can cope to only a certain limit that is determined by the developmental stage which he or she has attained. When at this limit. the individual’s. perceptions somehow inform him that the situation is beyond his ability to assimilate and accomodate (either because it is objectively so. or because it is believed to be so). As a result. the individual

engages in a negative, rigid, defending strategy which in turn removes or distorts the task required of him. If retreat as such becomes a stable, chronic strategy, the fragmentation mode emerges. Fragmentation is equated with psychosis. and while it may represent some sort of private victory, it is a social failure according to Haan. Take two examples from her taxonomy: the generic process of sensitivity becomes empathy in the coping mode, projection in the defending mode, and delusional thinking in the fragmentation mode. Selective awareness, another ego process, is concentration in the coping mode. denial in the defending mode and distraction or fixation in the fragmentation mode. At the center of Haan’s approach is her 30 category taxonomy of the 10 ego processes with three modes for each. Once Haan’s notions become clear-that the same ego processes manifest themselves in competent striving, defensive maneuvers. and psychosis-her theory looms intuitively and conceptually appealing. Haan attempts to operationalize these intrapsychic variables which, by their very nature, are difficult to pin down. And that is where some of the problems begin. At the most basic level, Haan’s descriptions of her 30 variables-her taxonomy-are somewhat weak in evidence of their external validity. Her variables demand subjective evaluation, and- thus are easily influenced by value judgments. Other researchers would be hard put to operationalize these variables adequately and subject them to empirical test. Sufficient information is simply not provided. This is unfortunate, since more research is necessary. Haan’s sample sizes (though understandably small from longitudinal studies over many years) are simply too small (and limited) for a major reconceptualization of personality theory. Her work is clearly pioneer, and she may be right, but unfortunately it will be difficult for other researchers to extend and incorporate her ideas. Haan’s book is a very real contribution to the field of personology. Despite its editorial and methodological limitations, Norma Haan’s work has much to say. She is without doubt bold and intellectually venturesome. An earlier reviewer of this book noted that it is easy to criticize the Wright brothers’ airplane and argued that we should look beyond the flaws to the strengths of Norma Haan’s book. I agree and I do. Yet similarly. despite the courage and inventiveness of the Wright brothers. I would not have been willing to climb aboard their airplane for a test flight. Perhaps, then. I am overly cautious. School of Medicine Uniwrsity of California Los Angeles. CA. U.S.A.

DAVID DANTE DINICOLA

Three Further Clinical Faces of Childhood, Edited by E. JAMES ANTHONY and

DORIS C. GILPIN. Sf Medical and Scientific Books. New York. 1981. 322 pp. Q25.00

This valuable book about hysterical. anxious. and borderline children combines the masterly touch and wide-ranging knowledge of Dr Anthony with the richness of a variety of approaches. A total of 24 authors have contributed to the volume, which constitutes the permanent record of a 2-day workshop at Washington University in St Louis. 1169

Book Reviews

1170

Among the theoretical and practical orientations of the contributors. the reader finds psychoanalysis. analyticallyoriented therapy. family therapy. transactional analysis. Piagetian theory. and social learning theory. Such a diversity might lead to chaos. but in the hands of the editors it does not. In practical terms. tying together the various approaches is accomplished by both introductory and summing-up commentaries by Dr Anthony at the beginning and end of each of the three sections. It seems likely that the fact that the majority of contributors are at the Washington University School of Medicine. known to each other and to the editors, also contributes to the mutually reinforcing and non-polemical tone of the conference and the resulting book. In this case, the house may be divided somewhat, but it is not divided against itself. In addition to Anthony, contributors of special note are Henry Coppolillo. Rudolf Ekstein, Paulina Kernberg, and Annemarie Weil. Each of the three subdivisions contains chapters on theory and clinical phenomenology as well as rich descriptions of therapeutic encounters and of the clinical management of patients and their families. A small amount of epidemiological material is also presented. Choosing almost at random from aspects of the book that impressed this reviewer, readers will find of particular value the review chapters by Ekstein on borderlines, Cop polillo on hysteria. and Weil on anxiety. Kernberg has contributed an interesting chapter in which she describes the relevance of the concepts of zone, state, and mode for character formation in the infant, and lists the various sorts of interpersonal factors which bear on it as well. Dr David Wells’ finding that “anxious personality children were raised significantly more by adoptive parents” will be of interest to those who work with adoptees or in child placement. Dr Anthony’s mention of physiological research on anxiety, including “ergotrophic” and “trophotrophic” reactions and their possible bearing on clinical management, was of interest. And Dr Ekstein’s compassionate exploration of the borderline state, making pointed and poignant use of the metaphors of “border” and “passport”, is particularly recommended. This book was a pleasure to read. and contains material to stimulate, inform, and provoke child therapists of any persuasion. My only quibble, and it is a small one, is that the book does not indicate the topics covered by the previous symposium and book, although the preface mentions that this is the second in a series. Department oj Child Psychiatry Mossuchusrtts Grnrrol Hospital Horwrd Medial School, Boston, MA, U.S.A.

STEVENL. NICKMAN

Needs. Edited by MAX SUGAR. 1980. 254 pp. S30.00

Responding to Adolescent

Spectrum,

New York,

This book is designed, according to Max Sugar, its editor. to be an examination of the environment currently encountered by the adolescent in our culture. and the ways in which aspects of it interfere with optimal development to adulthood. It originates from the premise that intrapsychic factors considered alone in any individual will often yield only a limited understanding and approach to helpful intervention. The individual adolescent operates within a family, a peer group, a school or work environment. He may have contact with the legal system. Political, economic, social factors all have their efiect. The premise is valid and long-established. The book, disappointingly, is uneven and less than optimally focused. Dr Sugar has organized the 15 chapters into several

sections in an effort to emphasize the different aspects of the adolescent’s experience: the family. the schools. law. health. sex and work. In the Family section. Derek Miller looks at adolescent behavioral symptomatology in terms of the farnIl> of or!gin. In comparing controlling and Impulsive families. he emphasizes that behavior which may be considered antrsocial should be viewed as less pathological when II expresses the mores of the adolescent‘s family and community. His chapter is well written and useful for the reader who has had little exposure to family dynamics. Johnstone and Johnstone’s concise chapter on famihes. communities and rebelliousness suggests that family pathology is more a determinant in higher socioeconomic groups. with peers and community influences playing a greater role in.poorer. more chaotic areas. The section ends with a criticism of state care of children by William Rittenberg. a lawyer. who decries an insensithity to children’s emotional needs and an over-readiness to substitute impersonal state take-over of children rather than support troubled families. A less impassioned. well-rounded consideration of government involvement would have been more helpful. A chapter on black families. the effect of prejudice on adolescents. and perhaps one about the welfare system would have made this se&on more comprehensive. The School section is a strong one. containing 2 chapters. Berkowitz’s chapter examines the schools as a site of confrontation between adults and adolescents. where unconscious factors in teachers can generate anger that leads to the ignoring of adolescent needs. Noblit and Collins write of the difficulties of black adolescents in integrated schools who respond to a devaluing of black culture by feeling that they must choose between academic success and pride in their own background and identity. Topics not covered which would be useful are the apparent decline in academic competence of American high school students and the reasons for it. and the problems of increased violence. alcohol. and drug use in the schools. I found Gotherd’s chapter on the Expanding Right to Treatment for Minors in the Law section unclear and too technical for the’ psychiatrist. Bortner’s treatment of Due Process and Protection was more helpful. recommending more attention to helping the adolescent understand and participate in his own legal fate. The Health Section includes a general overview of the types of mental health services available to adolescents, a chapter on the need for psychodynamic understanding of delinquency, one on the role of family dynamics in adolescent suicide and one on adolescent needs in medical care. The last chapter is the strongest. but seems directed toward primary care practitioners rather than mental health professionals. The section on Sex is the weakest in the book. Slovenko’s chapter on the laws against sexual exploitation did not seem clinically relevant and contained generalizations not supported by data. Sugar’s chapter on adolescent motherhood, certainly a critical and important topic. was top-heavy with statistics and disappointingly superficial. The two chapters in the work section were quite good. clearly written and thought-provoking. Scharf looks at the transition from school to work in terms of separation. loss und their mastery. Collins. Noblit and Ciscel examine the educational system as a means for preserving current socio-economic and racial stratification rather than maximizing individual opportunity. It is extremely difficult to compile a book like this that will be equally helpful to all professionals who come in contact with adolescents: teachers. social workers. pediatricians, general practitioners. psychiatrists. lawyers. etc. Sections on different areas are likely to be either too obvious and familiaf or too technical. a difficulty I found in particular with the legal area. I think Dr Sugar was attempting to edit a book for wide readership: I think 11