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Book Forum: CHILD PSYCHIATRY   |    
A Mind at a Time
Am J Psychiatry 2003;160:198-199. doi:10.1176/appi.ajp.160.1.198
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New York, N.Y.

By Mel Levine, M.D. New York, Simon & Schuster, 2002, 352 pp., $26.00.

The author is a pediatrician who in medical school discovered that while he was "a competent linguist" (p. 274), he "never had acceptable spatial ordering" and had "two left hands" (p. 274). He left dissecting to his anatomy partner, who had "expressive language trouble" (p. 274) but "superb visual motor abilities" (p. 274) and went on to be a surgeon. In their examinations, his partner would point out each blood vessel while the author would name it, and they both got honors.

True to his own kind of mind, the author’s popular guide to learning disorders is stronger in its taxonomy of learning woes than the options it offers for active intervention. Written for the lay reader, it provides anatomy-free conceptual schemata for our "neurodevelopmental" systems of attention, memory, language, spatial and sequential ordering, motor function, and conceptual and social thinking. A useful feature is a section titled "Minds Over Time" at the end of each section giving norms at each stage, much as Piaget and Anna Freud have described developmental lines. Interventions are largely limited to remedial practice, but the problems are so well specified and described that this is a great service. So much of what we teach in psychotherapeutic supervision is clinical tact, empathic manners, and, above all, language with which to explicate diagnostic and treatment theory in usable terms for patients. For any of us who deal with the cognitive problems of children, even in passing, this book, with its masterly setting up of case examples, is worth mining.

Levine has interesting things to say about the myth of laziness, about "dyssemia" (socially unacceptable body movements) (p. 235), and "motor intoxication" (overdosing with motor satisfaction) as well as motor humiliation. He does not consider cross-modality effects. For example, in an unpublished study of several ballet academies conducted while she was a student at Rye Country Day School, Westinghouse Science Award semifinalist Heather Fletcher showed that ballet training engenders academic excellence but that successful students are not necessarily the most able dancers. Levine says he has never seen a child’s mind so gifted that it had no weaknesses or a child without some area of "potential or actual giftedness" (p. 262). He is also, appropriately, as much against humiliation by teachers of those whose minds differ as he is of bullying by other students, and he has recommendations for the reform of schools to permit "the right to differ" (p. 307). For example, children should have staged "neurodevelopmental" instruction about "the mind that’s mine" (p. 316).

Levine feels that the IQ test is too limited. He says that "quite a few academic psychologists of the mind now acknowledge that there are many different kinds of intelligence" (p. 270) but does not cite Howard Gardner (1). He also says that the "vast majority of neurodevelopmental functions…described in this book are not brought out on any of the standard intelligence tests" (p. 270). All of this will please parents and reassure children by demystifying and compartmentalizing, even if learning progress is not made.

Levine’s recommendations might be even more useful and effective if they included adequate referral advice. The absence of the word "psychiatrist" in this book by a fellow physician is deafening, instead of indicating a psychiatric collaboration with the teacher and learning expert in more serious cases. Granted, Levine considers stimulants overused, and perhaps they are, but his opinions on the criteria for their use might be welcome. Without a scientific basis, he says antidepressants are a "Band-Aid, sometimes a cosmetic coverup" (p. 266) and that medication can never be curative, only remedial training can. Levine does not discuss schizophrenia and its cognitive problems, and he says that "terms like Asperger syndrome (commonly applied nowadays to kids with social gaps and strong areas of interest) are needlessly pathological in their connotation. Let’s say instead that a good kid needs some social assistance" (p. 242).

He places too much responsibility for children’s anxiety and mood disorders on parents. On the subject of learning, there is a discontinuity between the cheery expectation of change through specific kinds of remedial practice and the polite absence of any discussion of possible contributions to the origin of cognitive difficulties in the children’s longer experiences with their family environments.

Gardner H: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1985


Gardner H: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1985

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