Abstract
When asked to review the four volumes of the first edition of the Gale Encyclopedia of Children’s Health (Krapp & Wilson, 2005) for Reference Reviews (Guha, 2006), I prepared by going through the reference sections of the libraries of the Institute of Psychiatry, King’s College London, King’s College Hospital, the Institute of Child Health at Great Ormond Street and, finally, Blackheath public library, looking at child-related encyclopaedias. The results were astounding – I virtually disappeared behind a series of massive multivolume barricades, ranging in date from the five-volume Cyclopaedia of the Diseases of Children (Keating, 1889) to the comparatively modest two volumes of the Encyclopedia of Children’s Health and Wellness (Turkington & Tzeel, 2005. By the time I came to review the second edition (Guha, 2012; Longe, 2011), my colleague Penny Dade had reviewed the three massive volumes of the Encyclopedia of Child Behavior and Development (Goldstein & Naglieri, 2011) for the same journal, picking out three more encyclopaedias to supplement my list (Dade, 2011), and I then found two more printed reference tools to add to it still further. Between us, Penny and I dredged up enough child-related encyclopaedias to fill a sizeable library on their own – and all this even before starting to look online.
Judging from this, there must be an enormous number of awful things that can happen to children. Parents obviously need lots of guidance, and they certainly get it: an elementary search on Amazon Books (searched December 2014) for ‘child health’ + ‘2014’ brought up 155 relevant titles, and ‘parenting’ for the same year retrieved an unbelievable 343 hits, ranging from Commando Dad: How to Be an Elite Dad or Carer, to Moms Can Do Anything, to New Toddler Taming. Every newspaper and popular magazine seems crammed with stories of the harm which can be done to children, ranging from militant breast-feeders to legal actions against mothers who drink. It seems astonishing that any children have ever survived to adulthood more or less intact and only marginally traumatised.
Valerie Maholmes previously added to this pile of paranoia, with a study of the deleterious effects of growing up in poverty (Maholmes & King, 2012). She has now counterbalanced it with Fostering Resilience and Well-Being, a study of the ways in which some severely deprived American children manage to overcome adversity. In some ways, this is a curiously old-fashioned book. The sections on the effects of peer interaction, for example, are entirely concerned with direct contacts – extraordinarily, there is no mention of the Internet. Surely, for many of these children, both the adverse effects (bullying, peer pressure to conform, etc.) and the beneficial effects (online mentors and role models) of the social media are at least as important as face-to-face peer contacts. Nevertheless, Maholmes brings out some important factors in fostering resilience: hope, peer support (three youths in a gang neighbourhood agreeing to support each other in becoming doctors, successfully), parenting and teaching processes that foster self-confidence and empowering community groups. The emphasis on ‘hope’ may again come to appear dated. It is arguable that we are reaching the end of The American Dream – that a generation is arising in which parents cannot hope that their children will do better in life than they have.
Although some of the difficulties, and many of the opportunities, facing these children are unique to America, at least some of the lessons in this book are applicable to poor communities in other countries, making the book worthy of consideration by a wider readership. Maholmes’ previous book emphasised the negative, deleterious effects of poverty on children. This one, perhaps, overemphasises the positive – all the vignettes in it are of successes. The normal child must fit somewhere between the two.
Normal Child and Adolescent Development might be regarded as similarly unbalanced, as all the case vignettes apart from those in the final chapter seem to be of successes. All children cannot grow up to be doctors, or even ‘leading sommeliers’. Some have to settle by the wayside. This book also resembles Fostering Resilience and Well-Being in being entirely American-based and in appearing slightly old-fashioned. There is, as Gilmore and Meersand point out, considerable disagreement among psychodynamic thinkers about the legitimacy of the traditional developmental phases, most particularly the oedipal. This book, however, follows the traditional Freudian sequence: infancy, the mother/infant dyad; the toddler, libidinal object constancy and superego precursors; the oedipal phase; the latency phase; adolescence – here divided into pre-, mid- and late sub-phases; and the odyssey years, emerging into adulthood. The Eriksonian approach regarding development as a process extending through the entire life cycle is firmly rejected. Most chapters are linked to videos, available free on http://www.fosteringresilience.com/, intended to link psychodynamic developmental theory with what is actually likely to be seen in a therapeutic relationship.
The authors admit that many patients neither seek nor benefit from psychodynamic explorations. They claim, however, that even purely behavioural therapists will do better with a thorough understanding of human development. There are an enormous number of books on development, but this is one of the few recent texts to discuss the topic from a classical psychodynamic perspective and is therefore worth bearing in mind.
Scott Shannon has written two books in quick succession, covering broadly the same topic. I get the impression that Mental Health for the Whole Child was intended for mental health professionals and Parenting the Whole Child more for the general public. I am not sure that he has entirely succeeded. His folksy anecdotal style may seem slightly inadequate for professionals and the occasional technical term may prove an obstacle for lay readers. Yet again, his books are crammed with vignettes of rip-roaring successes. Mental Health for the Whole Child opens with ‘Henry’, son of a violent alcoholic Native-American prostitute who, after 10 weeks or so of informal art therapy, opened out and is now, 20 years on, a highly successful artist and silversmith. Are there no disturbed children in America who grow up to get by in humdrum low-grade jobs and more or less manage to plod through life? ‘Harry’ re-appears as ‘Sherman’ in Parenting the Whole Child, in more or less the same words, indicating the overlap between the two books.
Shannon’s basic argument is for a holistic view of child health – that ill-health comes from the interrelationship of genetics and the complete range of environmental factors: diet, family, sleep patterns, peer relations, community and so on – and therefore that to be successful, therapy should include tools such as diet controls, yoga, movement, acupuncture and excessive hugging, along with more formal therapies and medications where necessary. There is substantial evidence that certain dietary substances can have a profound effect on mental health and that exposure to traumatic events may have long-term consequences. In contradiction, however, it is possible to compare my birth cohort (February 1944) with contemporaries from societies with broadly similar Western cultures in the Netherlands and America. The Germans had deliberately removed all food stores from the Netherlands – many Dutch people died of starvation that winter, and some of the fiercest land battles of the Second World War were fought there (Lumey, Stein, & Kahn, 2007). My cohort were brought up under strict rationing, which enabled everyone to keep alive but certainly not overfed, amid slightly less traumatic events (I was born during an air raid). My American contemporaries were born in the highest level of employment, at a time of one of the lowest crime levels in American history, with access to plenty of food containing less of the additives which are causing concern today. I see no evidence at all to suggest that my Dutch contemporaries have suffered more long-term mental problems or the Americans very much less.
One thing that Shannon does not discuss is funding. Non-drug treatments take professional time and are therefore expensive. There is considerable evidence in Britain that ‘an alarming number of pre-school children are being prescribed drugs … because overstretched health workers go straight to medication rather than offering psychological interventions’ (‘Alarm over Hyperactivity Drugs’, The Guardian 22 December 2014, p. 1). A considerable proportion of Americans with troubled children do not have health insurance. However monotonously uniform Dr Shannon’s successes may be, they all take at least several weeks of treatment. There is considerable evidence of the over-medication of psychiatry in general and child health in particular. Drug companies make enormous profits from this, but the alternatives are not cheap: it is much easier for a hard-pressed general practitioner to reach for a prescription pad than to arrange for the sort of therapies that Dr Shannon is recommending.
There is growing evidence that diagnostic labelling is becoming less helpful. Parenting the Whole Child is a partial rewrite of Dr Shannon’s earlier book Please Don’t Label my Child. Diagnostic labelling has increasingly become a tool for insurance companies and a tool for drug company sales, rather than a tool for clinicians. The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) has grown over the years, so it has been estimated that about one-third of all Americans now fit into one of its categories. It has been suggested that, at this rate of growth, by the time DSM-7 appears it will cover everyone and can be retitled The Diagnostic and Statistical Manual of the Normal Human Condition, and we can then work on other tools for identifying people’s problems (Guha, 2014). In the meantime, these two books form timely reminders that children cannot be easily labelled, and such labelling may be actively harmful to them, that problematic behaviour can have multiple causes and, above all, that effective therapy should consist of more than naming a disorder and writing out a drug prescription.
After spending days ploughing through books on child development, all of which seem to emphasise disorder, The Madness of Modern Parenting came as a gloriously refreshing change. Basically, most children are ‘normal’, that is, on most measures of anything they fit somewhere on a statistically likely range. Children vary in their mental habits from a very early age – experiments on neonates have shown remarkable variations in attention, recognition and comprehension within a few hours of birth (which must have made for interesting scenes in the maternity ward). Almost any recommended method works well for some children and not for others. Children are remarkably resilient. Some recommended methods are based on inadequate evidence – it is probably true that breast-feeding is a bit better than formula feeding and that expectant mothers should restrict their alcohol intake, but some of the studies comparing feeding were made in countries such as the Dominican Republic and the Gambia, where a feed mixed with the local drinking water may well be unhealthy (and where, it might be pointed out, mothers will probably do better drinking beer rather than the water).
One point Williams does not mention is family size. The normal human procedure until historically recently was for families to have large numbers of children, many of whom died in infancy. Even in England, then the most economically and socially advanced country in the world, ‘families of six or eight children were still normal, and the modern one-child or two-child family did not, as a type, exist’ in the 1880s (Ensor, 1952). Modern Western humans are abnormal in not expecting any of their children to die before them. This makes the children seem more precious but, as Williams points out, the thrust away from luck and towards parental responsibility is really an attack on empathy: you don’t have to sympathise with that mother whose child is disabled, she probably didn’t eat the right vitamins … You don’t have to have fellow-feeling when that child was hit by a car … that child was unsupervised. You don’t have to feel for parents whose child is self-harming or anorexic – they probably put it in nursery too young and are now witnessing the consequences of its cortisol levels. We know by the evidence of our own five senses that the world can be cruel for reasons unrelated to irresponsible behaviour … Empathy is not misplaced and is a much more fulfilling emotion than scratching around to apportion blame.
Maholmes gives some encouragement and a few useful suggestions for people caring for children brought up in poverty: children are resilient. Gilmore and Meersand bring Freud’s psychoanalytic approach to child development up to date, pointing out, again, that most children are ‘normal’. Both Shannon’s books seem to me to overemphasise disorder rather than wellness, but describe helpful non-pharmacological treatments. Parenting the Whole Child is more aimed at parents, and Mental Health for the Whole Child at professionals, but the overlap is considerable. Everyone concerned with bringing up children, or even being likely to come across people bringing up children should read The Madness of Modern Parenting.