Henry N. Massie and Judith Rosenthal Childhood Psychosis in the First Four Years of Life New York: McGraw-Hill Book Company, 1984, 315 pages, $22.95
In the rapidly expanding field of infant psychology, a well-documented study of the earliest manifestations of childhood psychosis is a contribution of signal importance. Drs. Massie and Rosenthal have expanded their Early Natural History of Childhood Psychosis Project into a volume which embraces not only the details of their 10-year clinical studies but also a historical review of the mainstreams of thought about childhood psychosis plus a comprehensive exposition of normal infant emotional and cognitive development, including mother-child interaction.
The main body of the work is a detailed story of infant and young child behavior and mother-child interaction based on 16 cases. The method of study was unique in that it drew on home movies made prior to parents' or other observers' awareness of the child's deviant development. The premise was that observations made from such movies would not be distorted retrospectively by knowledge of illness. In fact, a system of observation and rating was devised so that those studying the movies would be blind to the diagnosis. Home movies of normal infants were used as controls. Development and clinical course after the first four years of life were tracked by means of ongoing case material, so that for each child there was an extended (up to 10 or more years) outcome study.
The book describes the Project's methodology in detail, both in the text, as well as in an appendix devoted to the Massie-Campbell Attachment During Stress Scale. Each child's behavior, emotional interactions, and cognitive development are dissected and categorized. A similar analysis is applied to parental style and manifestations of pathology. In addition, the therapy of one patient is described in detail. Thus, the clinical material is rich and weighty, even though based on only 16 cases. The changing clinical presentation as the infant grows is well-documented, as are the pathological elements of parental behavior. The authors finally arrive at an etiological formulation which makes a synthesis of their observations, current psychodynamic theory, and neurobiologie knowledge. Most valuable to the pediatrician are the tables summarizing salient behavioral features of patients, maternal attitudes, and the stylized drawings of mother-infant facial and body interactions.
Although a pediatrician might assume that the content is too specialized for the non-psychiatric practitioner, he would be in error. It is precisely for the primary care pediatrician that this book is valuable, because he is in the unique position of being able to make an early diagnosis, or at least to suspect deviant development, and because early treatment is the only hope of ameliorating this group of disorders. Thus, although the book, especially in its early chapters, may be too detailed for the pediatrician, the chapter summaries and tables present the material in a comprehensible, practical, and eminently usable fashion.
A close reader might find fault with the editing, for there are many distracting errors such as misspelling of proper names (Kazan for Kagan, Fraiber for Fraiberg), capitalization of disease as in Schilder's Disease, grammatical errors (had began), data used as a singular noun, and schema used as both singular and plural. An annoyance for which one cannot fault the editor, though, is the frequent reference to the infant as "it," and the occasional reference to the child as "kid." It is difficult to reconcile such neuter or impersonal terminology with sensitive, thoughtful clinical observation. To this reviewer, the litmus test of the sensitive clinician-observer is whether he conceptualizes the child as a person and a human being.
These details aside, Childhood Psychosis in the First Four Years of Life is an important contribution and a valuable addition to the practicing pediatrician's reference library.