annual progress in child psychiatry and child development, 1984

BOOK REVIEWS 675

latedness, and the acquisition of solacing linguisticcompetence, a point of view that supports the chal­lenge to Chomsky's view of language so essentiallybiologically regulated. A. Kris presents a most usefulconcept of a second paradigm of conflict, alongsidethe repression-defense paradigm of conflict. Deline­ated as the "conflicts of ambivalence," these clinicalpatterns of free association present as paired opposingcomponents that create painful tension as either sideis pursued without the other. A typical example wouldbe the adolescent's dilemma between wishing to growup and longing to remain a child. Resolution, via apendular oscillation between the two poles, is closelyakin to a mourning process, as contrasted with theresolution of conflicts of defense through increasingtension and the lifting of repression. Areas of appli­cation, especially in work with adolescents, are de­scribed. A third article that stands out is by Spero on"Shame," an attempt to relate the phenomenology andexperience of shame to issues in the development ofthe self.

The nine articles involving clinical contributionspresent material that is especially fascinating anduseful. Perhaps the most eye-catching title is Hitch­cock's discussion of "The Sinking Feeling," a screensensation reflecting an acceptance of a previouslydenied painful reality, and felt to facilitate the accept­ance of primitive separation experiences within thetransference situation. Grubrich-Simitis introduces ahelpful concept in the treatment of children of Holo­caust survivors. In an attempt to maintain denial ofthe traumatic past, the parents convey the impressionof their inquiring children that the object of theirinvestigations is not something that really happened.This pact of silence, defensively derived for survivalpurposes, serves to undermine the next generation'sconfidence in their own perceptions and differentia­tion of reality, and leads to a find of concretism thatprevents the discharge of aggressive fantasies. For thepatient to pass successfully from concretism to meta­phor, a "phase of joint acceptance of the Holocaustreality" must be mutually experienced by patient andtherapist. Balsam discusses "A Special Transference,"that of the "perfect patient" that follows the "basicrule" completely, but ends up leaving the therapist outof the process in a most fundamental way. Winnicott'sfalse/true self lines of dissociative ego states are usedto understand the phenomenon, although Balsam pre­sents arguments to change the terms false/true selvesto those of favored/repudiated selves. Other authorsoffer useful discussions concerning the impact of he­mophilia of the development of a set of twins, psycho­analytic aspects of the treatment of diabetic children,and the handling of aggression in child analysis.

At least two relative "taboos" are lifted in thisclinical section. In discussing the handling of aggres­sion in child analysis, Maenchen suggests limit settingin special situations as an "adaptation" of techniquethat allows the analysis to proceed. A. M. Sandlerargues effectively that if the problems of some elderlypatients represent the consequence of their failure tomake an appropriate developmental adaptation, ananalysis can be entertained with the goal, as withchildren, to restore the person to the path of normaldevelopment. She presents a limited but most inter­esting case of a 70-year-old woman in analysis.

In the section on Applications of Psychoanalysis,Solnit presents perhaps the most eloquent message,that, "Preparing a child for a potentially traumaticevent not only helps the child to cope with the im­mediate situation but is also a way of preparing thatchild's memory of it ... Each child is entitled to auseful and self-respecting past, one that gives him asound sense of his worth in the present and thefuture." The article should be distributed to all peoplewho see children in a medical setting. Other articlestouch upon subjects as diverse as prediction of person­ality outcomes, theraputic interventions with an abu­sive mother, parenting of infants born with birthdefects, defensive reactions to severe psychologicaltrauma, and the effect of trauma on the time sense.As a final item that enlarges one's analytic perimeters,Mahon and Battin-Mahon include a "Note on theGolden Section," an attempt to explain a centuries­old mystery on the preferential aesthetic attraction ofthe "golden rectangles." If a large number of peoplewere asked to evaluate the aesthetic merits of a selec­tion of rectangles of differing dimensions, over 75%would choose rectangles measuring some ratio of 5 by8. They suggest that this preference relates to theinfant's discovering the "golden ratios" of the humanface, and that these "first measurements ... not onlylead 'preobjectal' mentality toward object relatednessbut may leave an archiac imprint on man's aestheticpursuits as well."

This volume, as does its predecessors, reflects a highlevel of achievement. The articles are readable, wellorganized and of consistently high quality. The widerange of subject matter serves to enlighten, delightand stimulate the reader.

Annual Progress in Child Psychiatry and Child Devel­opment, 1984. Edited by Stella Chess, M.D., andAlexander Thomas, M.D. New York: Brunner/Ma­zel, 1985, 506 pp., $35.00.

Reviewed by Charles Hart Enzer, M.D. *• Doctor Enzer is in full-time private practice and Associate

Clinical Professor of Psychiatry at the University of CincinnatiMedical Center; Cincinnati, Ohio.

676 BOOK REVIEWS

This volume contains 32 articles from the 1983 liter­ature. Over 40%, however, are from only three of the15 journals represented. Two-thirds of these journalsare not medical journals.

Not represented are the 1983 issues of the AmericanJournal of Mental Deficiency, American Journal ofPsychotherapy, Archives of Diseases of Children, Ar­chives of General Psychiatry, Australian and New Zea­land Journal of Psych iatry, British Journal of Psychia­try, British Medical Journal, Canadian Journal of Psy­chiatry, Comprehensive Psychiatry, Journal of Autismand Development Disorders, Journal of Pediatrics,New England Journal of Medicine, Pediatrics, Psychi­atric Research, and Science. In 1983, these journalshad articles on many subjects neglected by the currentvolume; such as mental retardation, sleep, suicide, theDexamethasone Supression Test, psychopharmacol­ogy, obsessive-compulsive disorders, the surgical pa­tient, and rating instruments. For example, the Ar­chives of General Psychiatry included in 1983 Dr.David Shaffer's "Children's Global AssessmentScale."

Of the 32 articles, 10 are reviews of the literature.Unfortunately, rather than reviewing current andoriginal studies, these reviews predominately reviewolder review articles; for example, Michael Rutter's"Cognit ive Deficits and the Pathogenesis of Autism,"has 66 references of which only 18 are to the literatureof the 1980s. Only 8 of the references cited of the 66are to original studies rather than review articles.

Seven of the volume's articles are theoretical innature, but none are psychoanalytical.

Of the 15 original studies, 2 are sociological surveys,12 are prospective descriptive studies of a sociologicalnature, and 1 is a retrospective review of records.Because these studies lack control or comparisongroups, only tentative weight can be given to any ofthese descriptive studies. None of the original studiesis experimental in design.

Only 5 of the 32 articles deal with a diagnosis fromDSM-III. These clinical studies include autism, majoraffective disorder, anorexia nervosa, and bulimia.These are all review articles. But none of the reviewsof the clinical literature attempt to be critical of paststudies so as to provide a more rational basis for theclinician. The only original article concerning a DSM­III diagnosis is the descriptive study by MordecaiKaffman and Esther Elizur on "Bereavement Re­sponses of Kibbutz and Non-Kibbutz Children Fol­lowing the Death of the Father."

The emphasis of the articles is upon the "ChildDevelopment" aspect of the title. The emphasis isaway from the clinical practice of the child psychia-

trist. I question the use of "Progress" in this volume 'stitle.

The writer is forewarned, however, by the jacket'ssubtitle: A Selection of the Year's Outstanding Contri­butions to the Understanding and Treatment of theNormal and Disturbed Child. That is, the editors focusupon the "Disturbed Child" rather than the differen­tial diagnosis and specific treatment of the child suf­fering from one of the almost 300 specific psychiatricdisorders.

These review articles and original articles withoutexperimental design do provide me with ideas to thinkabout but not information upon which I can changemy own practice of child psychiatry.

Human Nutrition: A Comprehensive Treatise (Vol. 5,Nutrition and Behavior). Edited by Janina R. Galler.New York: Plenum Press, 1984, 532 pp., $49.50.

Reviewed by Carol Stratford, Ph .D., and Roland D.Ciaranello, M.D.*

In Nutrition and Behavior, Janina Galler has broughttogether a collection of chapters which examine thevarious interrelationships of human nutrition and be­havior. Although contributors include psychiatrists,psychologists, nutritionists, and anthropologists, witha few exceptions, the volume is well integrated. Antic­ipating a diverse audience, it contains a glossary ofspecialized terms as well as an extensive index . Eachchapter is self-contained, so that this volume servesas a reference text as well as a starting point forfurther research on any given topic within. Many ofthe chapters include extensive tables for comparisonsof the research studies they review. Because of thediversity of authorship represented in this volume , areader who is unfamiliar with the particulars of thefield is able to get a sense of some of the unresolvedcontroversies attending this subject.

The volume has two general divisions. The first partcontains chapters which discuss possible behavioralconsequences of abnormal nutrition. An excellent firstchapter by D. E. Barrett describes various methodol­ogies used in human behavioral studies. The authorillustrates potential problems and biases inherent tothis type of research with examples from studies onnutrition and behavior. He lists guidelines for plan­ning studies which are designed to limit problems inlater analysis of the data. These guidelines are prac ­tical reference points for the active research as well asfor the reader who wishes to interpret the literature.

Chapters on the behavioral consequences of mal­nutrition (J . R. Galler) and protein deprivation andnutritional supplementation (D. Rush) are generally

• Dr. Stratford and Dr. Ciaranello are from the Stanford Univer­sity School of Medicine, Sanford, Californ ia.