Book Reviews

Life Is With Others: Selected Writings on Child Psychiatry

by Donald J. Cohenedited by Andres Martin and Robert King

Yale University Press, New Haven, CT, 2006; 277 pp; $35

This rich and absorbing book is a memorial to Donald Cohen MD, bestknown to psychoanalysts from his work at the Yale Child Study Center andhis many papers elucidating psychoanalytic perspectives on psychopathologyand development. I begin this review by acknowledging with regret thatI missed the opportunity to know Dr Cohen, who was widely regarded as anextraordinary colleague and mentor to many of the most celebrated namesin child development research and child psychoanalysis today. Indeed thepicture of the man that emerges, both from this collection of his selectedpapers and presentations, and from posthumous tributes to him included inthe volume and elsewhere (see especially the section dedicated to his memoryin the Psychoanalytic Study of the Child 58, 2003) is, in my view, the apothe-osis of the North American child psychoanalyst: the clinician ⁄ scholar ⁄scientist who fearlessly integrates scientific research with a perspective com-mitted to understanding the mind of the child from a contemporary psycho-dynamic viewpoint, while remaining deeply respectful of psychoanalytictraditions. In this, as he notes in his chapter entitled ‘The Self under Siege’,he pursues Freud’s abandoned dream of linking ‘‘the neurological and con-stitutional factors on the one hand, and the dynamic processes of the uncon-scious mental life’’ (p. 84). Peter Fonagy, in his Foreword to this volumeand, with Mary Target, in their tribute published in the aforementionedPsychoanalytic Study of the Child (Fonagy and Target, 2003), speaks ofCohen’s ‘genius’ that found expression in his revolutionary integration, his‘brain-child’ discipline of psychodynamic developmental psychopathology.

Cohen’s autobiographical presentations in this book trace the roots ofthat integration in his personal intellectual history which sought to reconcilethe divergent views of development prevalent in the 1960s: that is, the Skin-nerian experimental model, where ‘‘the inner experiences of the child are anepiphenomenon’’ of operant conditioning of social behavior (pp. 17–18),and the Chomskian school emphasizing the pre-eminent role of the geneticblueprint. Cohen’s sojourn at Cambridge studying philosophy helped toclinch his choice, since he

learned that once split, the domains of the internal and external can only with diffi-culty, and perhaps not even then, be reintegrated; rather the challenge ... is to avoidthe original epistemological sin of dividing body and soul. Instead, we need alwaysto remind ourselves that internal and external world, mind and body, behaviorismand cognitivism, psychology and neurobiology reflect abstractions and can distortthe wholeness of natural phenomena.

(p. 18)

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Medical school and child psychiatry followed; his subsequent career is aremarkable negotiation between these poles. That he succeeded brilliantly isamply illustrated in his work on autism and Tourette’s syndrome, where theinterplay of basic science, clinical care, and his own indefatigable determina-tion to understand the subjectivity of his patients are woven together. Thefive chapters (1–5) devoted to that effort in this volume show his deeplyhumanitarian engagement with individuals who suffer the interpersonal rav-ages of neurobiologically-based disorders as he studied their brains and theirminds. His drive to gain access to the subjective experience and the anguishthat these disorders impose on patient and family seemed firmly groundedin an abiding curiosity and wonder about the mind of the unknowable other,as informed by psychoanalytic concepts, and his recognition of the complex-ity of developmental progression. In my view, his position, as illuminated byhis research and writing about these disorders, corrects many of the histori-cal (and, I fear, still extant) errors in psychoanalytic thinking about child-hood disorders and the developmental roots of adult psychopathology(Gilmore, 2008); that is, the errors perpetuated by failing to recognize theextraordinarily complex multiplicity of the origins of mental life and mentaldisorder. His work balances the contributions from neurobiological endow-ment, interpersonal exchange, unconscious mental life, subjective experience,and the on-going transformations of development to achieve a multi-systemview of the child. Interestingly, systems theory is not invoked in his work, asrepresented herein and in his other papers in the psychoanalytic literature,but it is certainly brought to the fore in the subsequent papers of his studentand collaborator, Linda Mayes (2001).

In the following two parts of the volume, ‘Hardworking Road Show: Playand Child Analysis’ and ‘No Safe Haven: Aggression, Violence andTrauma’, Cohen’s remarkable collaborations with younger colleagues are infull evidence. Every chapter, save one, is co-written with a colleague fromthe Yale Child Study Center and constitutes a significant contribution tochild analysis, child developmental studies, or applied psychoanalysis. Allare essential papers that have found their way into the curricula of psycho-analytic institutes and have been appropriately lauded in earlier testimonialsto Cohen’s many contributions (Mayes et al., 2003). In the opening para-graph of the first of this series, Enduring sadness: Early loss, vulnerability,and the shaping of character, Cohen puts forth his guiding principles andunderscores his ultimate commitment to the psychoanalytic viewpoint andpsychoanalytically informed clinical observation.

Throughout its history, the psychoanalytic theory of character has grappled withquestions about what it is to be a person and to have the mind that is specificallymy own. In approaching such concerns, the theory has bordered on philosophicalinquiry. Analysts have wondered about the origin of the self, the emergence of theinner world and its demarcation from the outer world, the organization of feelingsand fantasies which define experience, and the sense of continuity of the person overspace and time. We have speculated about the processes which differentiate people,with shared biology and mental mechanisms, into unique individuals of definabletypes. Recently, there has been a convergence of knowledge from child observation,genetic research, and psychoanalytic theory about temperament, socialization, and

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406 Book Reviews

stability of some characteristics, such as self-esteem. Observations within clinicalpsychoanalysis, however, continue to offer the deepest conviction. From clinicalengagement, we learn most deeply about the intertwined forces at the start of psy-chological life which provide the matrix for all future experience, the backgroundout of which our unique troubles and pleasures arise

(p. 108)

Cohen’s complex orientation, as delineated here, informs each of thesepapers, even while they are introducing groundbreaking ideas that have beenelaborated by the most prominent thinkers in child psychoanalysis today:these include the significance of trauma in development, importance of playas an exploratory technique in child work and as a (then under-recognized)vehicle for therapeutic action, the origins of aggression in primary attach-ment relationships, and the centrality of the acquisition of theory of mindfor object relations. For those who are unfamiliar with his work, thesepapers give witness to the breadth of his ever active mind and, from mypoint of view, represent psychoanalytic developmental thinking at its best.In each, Cohen and his co-author(s) bring together knowledge from neigh-boring disciplines that shed light on the emergence of key ego capacitieswhile maintaining the centrality of the psychoanalytic orientation as the pre-miere avenue to understanding the inner life of the child. Cohen does noterr on the side of the contemporary biologistic trend to place neuropsychiat-ric findings above psychoanalytic ones; even as he engages with the sur-rounding disciplines, he continues to maintain his focus on subjectiveexperience and personal meaning. Moreover, he does not content himselfwith an ivory tower approach; he brings that same orientation to his effortsto introduce the recognition of individuality and subjectivity to professionalswho work with disadvantaged children and families in the inner city.

It is for this reason, I believe, that the book was subtitled: Selected Writ-ings on Child Psychiatry. This amounts to a bid to be incorporated in thecurriculum of child psychiatry programs, reflecting Cohen’s apparent mis-sion to keep alive and central an interest in the mind of the child which,unfortunately, is slowly disappearing from child psychiatry training in theUnited States. His work is of great value in teaching, especially in the teach-ing of child psychiatry fellows but also of candidates in child and adultpsychoanalysis, because he avoids the pitfalls of a simplistic embrace ofneuroscience and basic science research and yet remains an active and com-mitted proponent of disciplined research and advances in knowledge fromneighboring fields. He continually reasserts the importance of subjectiveexperience and of meaning, even in explorations of neuropsychiatric disor-ders, where the mind’s struggle to make sense of the world, both inner andouter, can be brought into dramatic relief against the backdrop of invasionby disease into the fundamental operation of mental capacities.

The concluding section of the book, ‘Under Commodious Wings:Research and Mentorship’, includes two papers published outside the psycho-analytic domain. The first is a plea for research investigations of disadvan-taged populations on the basis of ‘ethical’ practice of child psychiatry andthe second is a manifesto on the responsibility of senior child psychiatriststo mentor, facilitate and promote the research careers of their younger

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colleagues. These are moving statements of Cohen’s profound respect forthe advancement of knowledge through research, best captured by the titleof the first of the two papers, The immorality of not knowing. What isremarkable for psychoanalysts is how he managed to maintain one foot ineach of these erstwhile antagonistic camps of empirical research and thepsychoanalytic search for meaning – and indeed to insist that the two areinseparable.

This book is a paean to Dr Cohen, and documents the worthiness of thattribute by the statements included therein, both of Cohen himself – all themore poignant because, in one case, delivered shortly before his death – andof others, whose personal and professional bereavement is palpable. Theseadditions to the scientific papers are equally important reading for traineesas well as colleagues, as they depict a professional posture that was optimis-tic, open and inquiring, generous to and supportive of the careers of his stu-dents and younger colleagues, and grateful to his mentors. For this childpsychiatrist and psychoanalyst and, I’m sure, many others, these papers areinspirational as they remind us, by example, of our responsibility to chil-dren, students, colleagues, and to psychoanalytic discovery.

Karen Gilmore305 East 18th Street, New York, NY 10003–2802, USA

E-mail: kjg23@columbia.edu

References

Fonagy P, Target M (2003). Being mindful of minds: A homage to the contributions of a child-analyticgenius. Psychoanal Study Child 58:307–21.

Gilmore K (2008). Psychoanalytic developmental theory: A contemporary reconsideration. J Am Psy-choanal Assoc. 56:887–907.

Mayes LC (2001). The twin poles of order and chaos: Development as a dynamic, self-orderingsystem. Psychoanal Study Child 56:137–70.

Mayes LC, Marans S, Downey TW, Fonagy P, Target M (2003). Section dedicated to the memory ofDonald J. Cohen, M.D. Psychoanal Study Child 58:269–321.

The Traumatic Area and the Institutional Field

by Antonello CorrealeBorla, Rome, 2007; 339 pp; e32

For more than 20 years Antonello Correale has been trying to fulfill arather difficult task, i.e. to combine his institutional experience in a Psychi-atric Counselling Service and his work as a psychoanalyst. In fact, he is apractising psychoanalyst and member of the Italian Psychoanalytic Societyand he is also in charge of the ‘Roma B’ psychiatric counselling centre serv-ing a large urban area. His latest book further testifies to the difficulty inreconciling these two roles, which is again mainly due to the tricky frontierwhere psychoanalysis and psychiatry meet and clash. Here Correale reviews,traces and expands on his thought and on his latest research: the traumaticarea and psychosis, borderline disorder, institutional groups and theirdynamics and other issues close to philosophy such as boredom andnarration in the last but significant part of this book devoted to in-depth

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408 Book Reviews