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Book Forum: Child/Adolescent Psychiatry   |    
Handbook of Infant Mental Health, 2nd ed.
Am J Psychiatry 2002;159:887-a-888. doi:10.1176/appi.ajp.159.5.887-a
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Berkeley, Calif.

Edited by Charles H. Zeanah, Jr. New York, Guilford Publications, 1999, 558 pp., $63.00.

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A pious Christian or Muslim needs and deserves a fine version of the Bible or Koran. A sea captain traversing the ocean should have a competent map. And every educated person who wants to assess, treat, or love a difficult baby must own a copy of this book. If you can’t find helpful information summarized here, relevant to any important or special problem pertinent to children ages 0–3, then the data do not yet exist. Now in its second edition (the first appeared in 1993), this volume is a massive, encyclopedic work encompassing all aspects of infant mental health. It has three major themes: 1) "infants are both like and unlike older children and adolescents," 2) "infants must be understood within a developmental context," and 3) "the care-giving context of infancy is essential" (pp. viii–ix).

Since I can’t find fault with the textbook’s comprehensive, marvelously written, and well-edited contents, I am restricted to questioning the choice of words for the title. The book’s contents are clearly focused on abnormalities and pathology of child development, not on "health." The term "mental health" is borrowed from a persistent but odd term still used in adult and adolescent psychiatry. Health resides in humans so transitorily that the use of this cheerful designation seems like a timid sop to the ancient fear, superstition, and impenetrability associated with mental illness. Since the editor, Charles Zeanah, asserts that the multidisciplinary field of infant psychiatry has now "come of age," can’t we call a spade a spade by using nouns like "disease" or at least "disorder"?

To return to the book’s contents, it contains contributions by 72 distinguished authors and is divided into six sections and 36 chapters. Section 1, Context of Infant Mental Health, tracks the infant through its psychological birth, showing how the infant’s primeval connection to the pregnant mother is neurobiologically transformed into a relational network between infant and care providers, which include the parents, siblings, and even therapists. Potential injuries that can threaten the newcomer’s existence (i.e., maternal mental illness or substance abuse, premature birth, poverty, or the consequences of adolescent parenting) are described in section 2, Risk and Protective Factors.

Section 3, Assessment, contains four chapters devoted to the psychological assessment of infants and toddlers, followed by the book’s fourth and longest section (158 pages), Psychopathology, which investigates early psychopathology. Here are found topics such as mental retardation, autism, posttraumatic stress disorder (quite a long stretch from the adult diagnosis), aggressive behaviors, and depressive conditions. There is a sophisticated research report from the Human Infant Sleep Laboratory at the University of California, Davis, by T. Anders et al., summarizing the current understanding of child sleep disorders.

Section 5, Intervention, is too brief in the light of rapid recent multiplication of pharmacological interventions for emotionally ill children. But its chapters do consider several individual and group therapy methods of treatment as well as institutional strategies. Its five chapters are thematically diverse. For instance, there is a fine, evidence-based chapter by L. Beckwith comparing programs designed to prevent child psychopathology that fail with those which succeed. A quite different kind of chapter by T. Field is devoted to the topic of massage therapy for infants, an intervention justified so far by speculations rather than by explanations of its biological effect. Quantitative research is amply highlighted in other parts of the book. The final and sixth section deals with applications of infant mental health concepts to national U.S. policies governing child care, divorce and custody, and development of standards for the education and training of future specialists in this fast-growing subspecialty of child psychiatry.

The book has about 2,000 bibliographic references. I am proud to be represented by a solitary publication. Sigmund Freud is also cited only once, and he too would have considered it an honor to be included.




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