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Book Forum: Child/Adolescent Psychiatry   |    
Stranger in the Nest: Do Parents Really Shape Their Child’s Personality, Intelligence, or Character?
ELISSA P. BENEDEK, M.D.
Am J Psychiatry 2002;159:1073-1074. doi:10.1176/appi.ajp.159.6.1073
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By David B. Cohen, Ph.D. New York, John Wiley & Sons, 1999, 312 pp., $27.95.

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For at least two decades, parents have been told that they are responsible for mental illness and emotional disorder in their children. Terms such as "refrigerator parent" or "schizophrenogenic parent" have contributed to the guilt, dismay, and unhappiness that parents who have a challenged child feel. That guilt has led to a vicious circle in terms of how parents act and interact with their children. In the past few years a number of books primarily authored by psychologists and social workers have pointed their fingers at mental health professionals for inducing these parental guilts, suggesting that parenting is a negligible factor in the growth and development of children into mature, responsible adults.

Although Dr. Cohen does not totally absolve parents from their parenting responsibilities, he has attempted to mitigate such responsibilities by illustrating with a series of anecdotes and brief descriptions of current studies the importance of genetics in child development. Dr. Cohen’s book is a quick, easy read. Most of the studies he cites are familiar to medical students, psychologists, psychiatrists, and other mental health personnel because they have been well publicized and are a part of the literature. Others are new, cutting-edge, and perhaps not so well-known. Dr. Cohen tries to be fair, but his central premise that "good parenting" cannot overcome "bad genes" is well known. He also repetitively makes the point that it is impossible to separate genetic background from environmental influence. No informed person would ever argue that one could. He illustrates his main points about the interaction of genetics and environment with a swimming pool analogy. I cite this anecdote in particular because it serves as an excellent example of the style and clarity of his writing and the points he wishes to make.

Pool depth is analogous to environmental stress so the greater the overall depth—the more stressful the environment—the higher the overall rate of drowning. A swimmer’s height is analogous to (genetic) vulnerability: the shorter the swimmers—the less able they are to stand at greater depths…the greater their risk of drowning. Because height is highly heritable with differences mostly genetic the potential for drowning must likewise be heritable. This is true even if at any given time no one drowns. If there were little water in the pool, differences in height would account for nothing. It is only when water levels are high that individual differences, in this case genetic differences, can be significant.

Just as swimmers’ height is analogous to (genetic) vulnerability, pool depth is analogous to stress from parents and siblings (family life), peers and politics (community life).

Cohen uses this example to illustrate why the suicide rate of American men increased from 1960 to 1990, suggesting that it was not only genes at work increasing the incidence of suicidality, because genes don’t change in a 30-year period, but something different in the environment. He reports changes affecting the quality of parenting, including family instability, divorce rates, levels of violence, and decrease of traditional standards. Although he makes the point repetitively that genes are critical, he grudgingly admits that some therapies influence genetic determinism. He is not specific as to which therapies. Little or no mention is made of psychotherapy, behavioral therapy, psychopharmacology, or any of the therapies available to the traditional psychiatrist.

The central thesis of this book is made clear on the back cover of the jacket:

The truth of the matter is that, if sufficiently strong, inborn potentials can trump parental influence, no matter how positive or negative. Some traits manifest themselves in such unexpected and uncontrollable ways that, for better or for worse, one’s child may indeed seem like a perfect stranger.

Dr. Cohen is certainly most able to abstract and argue convincingly that new knowledge in genetics must be taken into account as we try to understand human vulnerabilities and frailties. It would be impossible and not sensible to try to refute that argument. However, in making as strong a case as he does for genetics, Dr. Cohen does not present a balanced argument. This book will be most helpful for parents as a psychoeducational tool. Professionals who treat parents and children cannot help but look on their own experience in the nature/nurture equation and realize how much influence genetics brings to the table. Mental health professionals will find the book entertaining but not that valuable as a resource for enhancing their knowledge or skills.

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