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Unwritten Rules of Social Relationships: Decoding Social Mysteries through the

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BOOK REVIEWS
Animals in Translation. By Temple Grandin and Catherine
Johnson. New York: Scribner, 2005, 356 pp., $25.00 (hardcover).
The notion that autistic people are in and perhaps of an-
other world, apart and unto themselves, in the sense of idio-
and all its derivatives, including the shocking contumely that is
idiot (from the Greek idioteia, uncouthness or lack of educa-
tion) has set the stage for the way in which autistic people have
typically been viewed by their ‘‘neurotypical’’ counterparts.
The autistic person is taken to be inaccessible, emotionally re-
mote, and, though worthy of sympathy, ultimately detached
from life as it should be lived, in its emotional and perceptual
fullness. From the human point of view, animals, too, have
been viewed as such, limited and therefore lower or handi-
capped beings. The bold claim of Grandin and Johnson’s An-
imals in Translation is that all views of this sort are false. Their
argument is that animals and autistic people are privy to more
of the world an sich than the neurotypical human. ‘‘They are
totally detail-oriented. That’s the key’’ (p. 31). And ‘‘Normal
people see and hear schemas, not raw sensory data’’ (p. 65).
These schemas protect but also isolate them from the ‘‘bloom-
ing, buzzing confusion’’ of Jamesian sense-data.
The price human beings pay for having such big, fat frontal lobes is that
normal people become oblivious in a way animals and autistic people aren’t.
Normal people stop seeing the details that make up the big picture and see only
the big picture instead.. (p. 57)
I must point out that though the book under review will be
read by many initially because it is about autism by someone
with autism (Grandin), in fact it is also a book about the re-
lationship between autism and animals, written by a gifted
animal scientist who happens to be autistic and to love
animals. Some parts of the text (for example, the whole of
Chapter 4, ‘‘Animal Aggression’’) have nothing to do with
autism at all, but are wholly ethological. Grandin and John-
son are here extending earlier work by Grandin, which uses
her own autistic insight to understand animal behavior, de-
ploying it to startling advantage, for example, in connection
with color and simultaneous contrast perception, and with
the perception of novelty. The book has an appendix titled
‘‘Behavior and Training Troubleshooting Guide’’ that is in-
tended to be and will be of use to professionals and others
dealing with problem behavior in animals, and the whole
book is filled with unfailingly interesting detail. Did you
know, for example, that dung beetles perceive the polariza-
tion of moonlight?
Grandin and Johnson are of course not the first to describe
autistic people from an essentially perceptual psychological
J. AM. ACAD. CH ILD ADO LESC. PSY CH IATRY, 45:1, JANUARY 200 6
Copyright 2006 © American Academy of Child and Adolescent Psychiatry.
Unauthorized reproduction of this article is prohibited.
Assistant Editor: Andr
e s Martin, M.D., M.P.H.
point of view, focusing on what Uta Frith calls ‘‘weak central
coherence.’’ (Whether it is true of animals that they see only
details or whether they merely see different details is an im-
portant question.) What is novel in the book is the positive
respect Grandin and Johnson afford to those humans so
blessed, or so cursed, with autism. In nonautistic people,
positive descriptions of weak central coherence have typi-
cally been reserved for the gifted and the extraordinary, such
as the aesthetes, the mystics, and the mathematical geniuses.
In The Creative Mind, Henri Bergson (1946) writes
Perception, the auxiliary of action...isolates that part of reality as a whole that
interests us.we scarcely look at the object, it is enough for us to know to which
category it belongs. But now and then, by a lucky accident, men arise whose senses
or consciousness are less adherent to life. (p. 162)
Bergson was unfortunate to live before the time of the
modern evidence-based psychiatric classifications, but here
we have a positive description of what Grandin and Johnson
take to be the central fact of autism spectrum disorders.
Bergson writes that ‘‘it is because the artist is less intent
on utilizing his perception that he perceives a greater num-
ber of things’’ (p. 163). Grandin and Johnson write ‘‘a nor-
mal person’s nervous system gets rid of a lot of detail and
then fills in the blanks with whatever he expects to see,’’
the process of which they call abstractification: ‘‘The problem
with normal people is that they’re too cerebral. I call it being
abstractified’’ (p. 27).
I always find it kind of funny that normal people are saying autistic children
‘‘live in their own little world.’’ There’s a great big, beautiful world out there that
a lot of normal folks are just barely taking in. Autistic people and animals are
seeing a whole register of the visual world normal people can’t, or don’t. (p. 24)
Whatever terms are used, the interplay between detail and
abstraction clearly underlies some of the behaviors unique to
autistic people, and it is helpful to have it described by some-
one like Grandin who knows the condition from the inside
and first hand. We know that many autistic people have dif-
ficulty with their sensory modalities: tactile, visual, auditory,
gustatory, and olfactory. These irregularities are consistently
characterized by hypersensitivity, e.g., to loud noises, to
scratchy fabrics, and so forth. Here, too, as neurotypicals
blessed with the strong ability to categorize, our responsibility
is to recognize ‘‘other minds’’ by overcoming our own
‘‘mind-blindness’’ (Simon Baron-Cohen’s term and catchy
1997 book title) and to understand that valuable lessons
can be learned from the way animals and autistic people per-
ceive and understand the world. If we do not recognize the
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BO OK RE VI EWS
(to us) strange mind of autism, we render ourselves partially
autistic. This is what Animals in Translation charges us with.
But be warned . there is wading to be done to encompass
this book. It is a strange gallimaufry, as ponderously gaited as
a giraffe, equally alien, yet equally splendid. Although this
book may be cast off as a novelty ex luna, I hope deeply that
it will resonate as a plea from an ambassador for those who do
not speak for themselves.
Alexander R. N. Westphal, B.A.
Brown University Medical School
Providence, RI
DOI: 10.1097/01.chi.0000186446.26709.33
Disclosure: The author has no financial relationships to disclose.
Bergson H (1946), The Creative Mind. New York: The Philosophical Library
The Many Faces of Asperger’s Syndrome. Edited by Maria
Rhode and Trudy Klauber. London: Karnac Books, 2004, 302
pp., $33.95 (softcover).
What is Asperger syndrome? In particular, what are the
subjective experiences of children and adolescents affected
by it, how can the process of psychodynamic psychotherapy
be tailored to its needs, and is this therapeutic approach ul-
timately useful? Drawing heavily on the Tavistock Clinic’s
long history of psychodynamic work with autistic spectrum
disorders, the authors set out to address these core questions.
In so doing, they paint a rich landscape. Psychological and
psychoanalytic theories are carefully considered for their rel-
evance not only to Asperger syndrome, but also to Hans
Asperger’s classic 1944 paper, ‘‘ÔAutistic Psychopathy’ in
Childhood.’’ Central to the authors’ collective perspective
is Wilfred Bion’s theory of containment, which provides
for the development of cognitive processes from emotional
relationships. As the authors point out, this model is consis-
tent with findings of neurophysiologic studies of mother–
infant dyads, in which neuronal activity is relationally mod-
ulated. Differential diagnosis is discussed historically, psy-
chodynamically, and phenomenologically. Psychopathogenic
mechanisms are postulated, always with a thoughtful eye to
psychotherapeutic intervention. These varied lines of explora-
tion weave a sturdy fabric into which a wealth of case vignettes
and histories are effectively interwoven. The case material, poi-
gnantly conveying a great deal about the experiences of indi-
viduals diagnosed with Asperger syndrome in psychotherapy
and in life more generally, is the central means by which
the authors meet their ambitious objectives successfully.
120
Copyright 2006 © American Academy of Child and Adolescent Psychiatry.
Unauthorized reproduction of this article is prohibited.
What emerges is a picture of children and adolescents
with primary deficits in socialization, communication, and
imagination who are deeply desirous of interpersonal attach-
ment, yet fearful of rejection and abandonment and, there-
fore, drawn to a variety of self-encapsulating defenses. These
defenses include, for example, the pursuit of narrow and sol-
itary interests, the preoccupation with detailed and factual
information, and the repetition of stereotyped and often self-
stimulating rituals. Together with the primary deficits, those
defenses do, in fact, place them at greater than average risk of
experiencing the very marginalization they fear. In develop-
ing this formulation, the authors take appropriate and con-
vincing care to differentiate it from misconceptions of the
work of Leo Kanner and Bruno Bettelheim, in which parents
of autistic infants and children were described as causally
emotionally damaging. In addition, throughout their ex-
plication of the dynamics of Asperger syndrome, the authors
consistently and explicitly acknowledge the existence of in-
nate, if still poorly understood, neurobiological deficits.
The clinical material is moving, and among those individ-
uals whose histories and vignettes were selected for inclusion in
the book, the reader gains tremendous perspective into the
world of Asperger syndrome and on the potential for psycho-
dynamic psychotherapy to attenuate fears, modify defenses,
and realize interpersonal desires more fully. For example, chil-
dren with Asperger syndrome are given to repetitious, mini-
mally modulated speech and highly ritualized worklike play.
In sessions, this behavior can have a hypnotic, disengaging ef-
fect on the therapist. Thinking countertransferentially, the ther-
apist can share in and, thereby, penetrate the child’s subjective
experience of social isolation. Connected in this way, to the ther-
apist and to an outside perspective, the child then has the po-
tential to develop stronger theory of mind skills and, in the
words of Peter Fonagy, new ways of ‘‘being with the other.’’
Despite its many merits, the book leaves the reader won-
dering about those children and adolescents with Asperger
syndrome who were not selected for psychodynamic psycho-
therapy at London’s Tavistock Clinic and, by extension, for
inclusion in the book. The editors acknowledge that psycho-
dynamic psychotherapy is not of benefit to all children with
Asperger syndrome. They choose, however, not to address the
questions involved in an assessment for such psychotherapeu-
tic ‘‘fit.’’ This omission is surprising and disappointing.
Psychodynamic psychotherapy, with the Tavistock Clin-
ic’s emphasis on the British school of object relations, is in
a sense the authors’ principal methodology; it is the way
by which they arrived at the preponderance of their data.
Given the book’s explicit objective of illustrating the wide
range of individual differences encompassed by a diagnosis
of Asperger syndrome and its implicit objective of demon-
strating the effectiveness of psychodynamic psychotherapy
for the condition, it would have been helpful to know
J. AM . ACAD. CHILD ADOLESC. PSYCHIATRY , 45 :1, JANUARY 20 06

something about the characteristics and number of individ-
uals who were excluded from treatment. The editors note that
the children described in the book were unrepresentative in
that more girls were part of their sample than is true of people
with Asperger syndrome in general. This note applies also to
the adults with Asperger syndrome who were included in the
book (all are women), and it falls short of acknowledging
other ways in which the individuals selected for description
in the book may be unrepresentative.
One author, Graham Shulman, ventured to acknowledge
that significant theory of mind skills and capacity for affective
interpersonal relatedness, although common to many of the
cases depicted in the book, are characteristics often not re-
garded as consonant with Asperger syndrome. Accordingly,
among the book’s authors, he was uniquely conservative in
endorsing the effectiveness of psychodynamic psychotherapy
for the condition. A chapter that described the process by
which individuals were selected for psychotherapy would
have helped to address the generalizability of the authors’
findings and recommendations. As it is, the reader is left with
the impression but not the convincing conclusion that most
individuals with Asperger syndrome, behind their character-
istic deficits and defenses, are desirous of and in fact capable
of significant social engagement. If so, then this finding ought
to shape substantially our diagnostic perspective and treat-
ment planning.
Daniel T. Chrzanowski, M.D.
Michael Feldman, M.D.
Department of Psychiatry
College of Physicians and Surgeons
Columbia University
New York
DOI: 10.1097/01.chi.0000186447.26709.7a
Disclosure: The author has no financial relationships to disclose.
Learning and Behavior Problems in Asperger Syndrome.
Edited by Margot Prior. New York: The Guilford Press, 2003,
326 pp., $42.00 (hardcover).
I was excited to read this book from the moment I saw the
title. As a general psychiatric resident planning on entering
a child and adolescent fellowship, I was hopeful this book
would help me understand the differences between Asperger
syndrome (AS) and high-functioning autism, teach me how
to diagnose patients earlier, and how to best help this unique
patient population. Before I finished the first chapter, I was
quickly pulled back into reality and reminded that under-
standing the human mind is never simple. And I soon found
J. AM. ACAD. CH ILD ADO LESC. PSY CH IATRY, 45:1, JANUARY 200 6
Copyright 2006 © American Academy of Child and Adolescent Psychiatry.
Unauthorized reproduction of this article is prohibited.
B O OK R EV I EW S
myself questioning whether I had ever used the phrase ‘‘As-
perger syndrome’’ or ‘‘high-functioning autism’’ correctly.
Throughout the book, Dr. Prior and the chapter authors
coherently organize the information from specialists from
around the world. Also, the frequent use of case studies helps
the reader focus, first and foremost, on the patient. The book
begins by highlighting the multitude of different diagnostic
criteria used to classify learning and behavior problems seen
in children since the 1940s. With that, it is nicely impressed
on the reader to view autism as a spectrum disorder, with AS-
being a point on that spectrum.
The book was organized in two main sections: ‘‘Assessment
and Management of Behavioral and Learning Difficulties’’ and
‘‘Asperger Syndrome in the Schools.’’ In the first section, each
chapter focuses on a distinct category of deficits seen in autism.
For example, in his chapter on circumscribed interests, Tony
Attwood discusses how these interests evolve over time and
how parents, teachers, clinicians, and patients themselves view
them. He continues by presenting theories that try to explain
why circumscribed interests develop in those with an autistic
spectrum disorder (ASD), and he ends the chapter with strat-
egies on management of the interests. Dr. Attwood states that,
with patients who have acceptable interests, the focus of pa-
rents and teachers should not be on the ‘‘activity itself but
the duration and dominance over other interests’’ (p. 138).
The use of a timer or clock to establish specific allotments
of time during the day, coupled with a replacement activity
that ‘‘the person enjoys, even if it is not as enjoyable as the cir-
cumscribed interest’’ (p. 138), is one approach to broaden the
person’s range of interests. If the interest is potentially dan-
gerous or illegal, Dr. Attwood recommends using the ‘‘Social
Stories and Comic Strip Conversations’’ developed by Gray
(1998) to explain why the interest is not acceptable. The
foundation of information beneficial in recognizing and un-
derstanding the unique problems faced by these individuals is
laid down in this section. This book will make an excellent
addition to my reference library because the chapters are
organized well and I am able to access information easily.
The second section begins with Wendy Lawson’s personal
account of the difficulties she faced in the schools she attended
as a child. Readers are given a rare opportunity to see into the
mind of someone diagnosed with ASD. Then, Val Gill, prin-
cipal of the Western Autistic School in Footscray, Australia,
shares some of the wisdom she has attained during her 20 years
of teaching students with ASDs. I found her analogy of two path-
ways to be very helpful. ‘‘One is our normal pathway, and the
other is an ASD pathway’’ (p. 197). It is our job to bridge the gap
between the two and ‘‘ [that] bridge is built through understand-
ing’’ (p. 197). The realization that changes need to be made in
the way students with AS are approached in school is one of the
first steps in decreasing the confusion and frustration felt by
teachers and students alike. Val Gill reminds us to always
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remember that students with AS are extremely literal and will
have difficulties with the complexity of our language (e.g.,
sarcasm, humor). ‘‘We need to remember that they don’t have
access to our rich internal imagery, or natural ability to be
flexible and imaginative in their use of language’’ (p. 201).
The section continues with discussions on the unique ob-
stacles to learning and recommendations for modifications
in the classroom that facilitate a more rewarding school ex-
perience for students and teachers alike. Parents and teach-
ers involved with autistic children will benefit greatly from
the advice offered in this section.
I thoroughly enjoyed reading this book and I believe
anyone interested in the development of children (physi-
cians, psychologists, teachers, and parents) would find this
book valuable. It is not often that I come across a text that
brings together information from so many noted clinicians,
includes the many facets of a disorder, shows how to better
meet the needs of the unique individuals with the disorder,
and is compiled into a user-friendly format. If only the text-
books from medical school could be read as easily and
enjoyably.
Cornelio R. Ruperto, M.D.
Department of Psychiatry
Wake Forest University School of Medicine
Winston-Salem, NC
DOI: 10.1097/01.chi.0000186448.64826.ff
Disclosure: The author has no financial relationships to disclose.
Gray C (1998), Social stories and comic strip conversations with students
with Asperger syndrome and high functioning autism. In: Asperger
Syndrome or High-Functioning Autism?, Schopler E, Mesibov GB,
Kunce LJ, eds. New York: Plenum Press, pp 167–198
Why Love Matters: How Affection Shapes a Baby’s Brain.
By Sue Gerhardt. New York: Brunner-Routledge, 2004, 246
pp., $17.95 (softcover).
Since John Bowlby first introduced the attachment model
three decades ago, the importance of a secure parent–infant
relationship on human development has been widely recog-
nized and studied. For many of us, however, it is not yet clear
how early parenting can induce changes in brain development
that can be related to later psychological problems. This is
what Sue Gerhardt sets out to elucidate in her book, Why
Love Matters. Using evidence made possible by recent tech-
nical advances in neuroscience, the author shows that adverse
early experience with parents can lead to long-term impair-
ment in the brain and that a loving parent-child relationship
really does matter for psychological well-being.
122
Copyright 2006 © American Academy of Child and Adolescent Psychiatry.
Unauthorized reproduction of this article is prohibited.
Rather that being full of unnecessary jargon, this book is
written in an easy language intended for a broad range of
readers, even those without a background in neuroscience.
Despite the simplicity of language, this book goes into con-
siderable depth. Gerhardt reviews a great deal of literature
covering the importance of different brain areas and neuro-
endocrine systems important for mediating parenting effects
on babies, as well as psychopathological disorders that may
develop when there is neglect or abuse. Gerhardt begins by
pointing out how plastic human babies’ brains are as they
constantly interact with the outside world. Their brains go
through a ‘‘pruning process,’’ a rewiring of connections that
are either fortified or removed according to external stimuli.
Gerhardt illustrates the effects of parenting on the develop-
ment of the orbitofrontal cortex (OBFC), which she also re-
fers to as the ‘‘social brain,’’ and which plays a critical role in
emotion regulation and social interaction. Although warm
and responsive parenting during the first year of a baby’s life
may contribute to the normal development of the OBFC,
cold and unresponsive parenting hampers it. Such structural
and functional variations in the OBFC can lead to more dif-
ficulties in emotion regulation and social life as babies grow
older. Furthermore, the OBFC is linked with hypothalamus,
the area responsible for the regulation of the stress hormone
cortisol. Gerhardt explains that being completely dependent
on their parents during the first 12 months of life, babies ex-
perience high stress when their caregivers are unresponsive
and inconsistent. The lack of emotional security and of nor-
mal development of the OBFC can lead to chronically abnor-
mal cortisol responses, which may in turn lead to longer-term
difficulties in stress regulation.
In addition to the readable physiological review, Gerhardt
presents numerous clinical anecdotes. She is a psychoanalytic
psychotherapist and takes advantage of her experience to in-
clude actual cases of people with various psychological prob-
lems that may be attributed to impaired brain development
under negative early experiences with their parents. One of
the cases is about people having grown up with a depressed
mother whose parenting style tends to be less responsive and
neglectful: Studies have found in these people a higher cor-
tisol level and fewer cortical receptors, making them more
susceptible to stress and prone to depression. Gerhardt intro-
duces other cases in which babies are exposed to sexual abuse
by their parents. These babies are more likely to have a dis-
organized attachment style, characterized by fast shifts be-
tween approach and avoidance with others, and eventually
subject to higher rates of borderline and narcissistic person-
ality disorders and posttraumatic stress disorder. Moving
back to the physiology, the author discusses how this is sup-
ported by neurological findings in people with posttraumatic
stress disorder in which the hippocampus, the brain region
responsible for event evaluation, is relatively smaller in
J. AM . ACAD. CHILD ADOLESC. PSYCHIATRY , 45 :1, JANUARY 20 06

volume. They also exhibit abnormal regulation of cortisol lev-
els and poor functioning of emotional circuitry that involves
the OBFC. Babies under coercive parenting have an avoidant
attachment style, which may explain their higher tendency to
develop antisocial behavioral problems. They are found to
have a smaller OBFC and higher cortisol levels.
Gerhardt does a decent job connecting parenting styles
during infancy with psychological problems much later
in life; however, she leaves the larger questions of what
may happen in between and how to best address these prob-
lems entirely out of the book. These are questions that
research-oriented child and adolescent psychiatrists are just
starting to address and of critical importance to guide treat-
ment interventions.
Toward the end of the book, Gerhardt attempts to offer
suggestions addressing the importance of the early parent–
child relationship. She does not simply say that parents
should stay home and devote their entire time to taking care
of their babies. Instead, she leads us to recognize how stress-
ful it is to be a parent, especially when one is unprepared.
She suggests a viable solution will require participation by
the greater society. In fact, early parental preoccupation and
stress, which to some extent are a normal part of parent–
infant bonding (Mayes et al., 2005), may be more problem-
atic in circumstances of poverty, war, or parental mental
illness. This underlines the importance of Gerhardt’s dis-
cussion of the needs for intervention and policy designed
specifically to support positive parenting for the sake of
future generations. For anyone who has an interest in
the intricate relationship between the brain, mind, and
behavior from a developmental perspective, this book offers
a wonderful read.
Pilyoung Kim, M.Ed.
Cornell University
Ithaca, NY
James E. Swain, M.D., Ph.D., F.R.C.P.C.
Yale Child Study Center
New Haven, CT
DOI: 10.1097/01.chi.0000186449.72450.c2
Disclosure: The author has no financial relationships to disclose.
Mayes LC, Swain JE, Leckman JF (2005), Parental attachment systems:
neural circuits, genes, and experiential contributions to parental
engagement. Clin Neurosci Res 4:301–313
Perfect Madness: Motherhood in the Age of Anxiety. By
Judith Warner. New York: Riverhead Books, 2005, 327 pp.,
$23.95 (hardcover).
J. AM. ACAD. CH ILD ADO LESC. PSY CH IATRY, 45:1, JANUARY 200 6
Copyright 2006 © American Academy of Child and Adolescent Psychiatry.
Unauthorized reproduction of this article is prohibited.
B O OK R EV I EW S
To understand why this chaotic, poorly researched rant
about motherhood has become a national bestseller, it is im-
portant to distinguish between Warner’s accurate description
of the perfect madness that has overwhelmed and distorted
the experience of motherhood for some middle- and upper
middle-class mothers and her allocation of blame for this
problem. From the start, Warner clearly describes feelings
with which many privileged women are achingly familiar:
the pressure to be a ‘‘perfect’’ mother. Today’s definition
of perfect has much in common with the perfect mother
of the 1950s-that domestic goddess par excellence-but is
compounded by the push to be available, stimulating,
and otherwise developmentally facilitating to their off-
spring: the perfect play date, the perfect birthday party,
the perfect babysitter (who not only loves the child and
provides him or her with just the right levels of cognitive
stimulation but perhaps teaches him or her a second
language as well). This can often be carried to ridiculous
extremes, with women feeling that only if they subsume
all of their other desires and interests are they being good
enough parents. Warner correctly points out that such pre-
occupations really interfere with the quality of women’s
lives: Indeed, it is no way to live. Warner further accurately
notes, based on her own experience living and raising chil-
dren in France, that there are other Western cultures that
are far more supportive of motherhood in general and of
women’s complex needs to find fulfillment in work and
other relationships in particular.
My suspicion is that many of the women who bought,
read, and raved about this book to their friends read only
the first few chapters, which nicely lay out what Warner de-
scribes as the ‘‘mess’’ of motherhood among today’s affluent
mothers, although it must be emphasized (which Warner
barely does) that many women of privilege do not fall prey
to this kind of internal pressure. But when they do occur,
such preoccupations are certainly a function of choice and
privilege; women with fewer choices are far less likely to
choose to stay up all night making the costumes for their
child’s kindergarten play or be driven to seek the ‘‘right’’ play
date for their child’s social and emotional development. It
is after these opening chapters that the book really falls apart.
Struggling to find a reason for this ‘‘mess’’ (and in my opin-
ion failing to look in any of the right places), Warner quickly
lapses into a diatribe that is full of rampant overgeneralization,
utter misrepresentation of primary sources (of which there
are woefully few), and extreme examples of maternal over-
achievement that even the most driven and ambitious parents
would reject as bizarre and out of the realm of the ordinary.
She suggests, for example, that Andrea Yates was driven to
drown her children in part because she could not live up
to the ideals of perfect motherhood. Andrea Yates drowned
her children because she was mentally ill, in particular,
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psychotic. Although many mothers certainly struggle with the
feeling that they should do more and more for their children,
I think few women would mistake their overachievement for
Yates’s profound depression.
In her effort to explain why some women find themselves
swept up in the pressure to create a perfect universe for their
children, she never looks to the women themselves. Instead,
she chooses a series of straw men for her derision. Her first
target is John Bowlby. One paragraph reads (in its entirety) as
follows: ‘‘A great deal of this had to do with one man and one
idea: John Bowlby and his notion of Ômaternal deprivation’’’
(p. 92). She then goes on, in a new paragraph, to describe him
as ‘‘a psychoanalyst who studied birds’’ (p. 92); he was fas-
cinated by the ideas of Lorenz and Tinbergen about innate
releasing mechanisms in geese but did not study birds per se.
After this incorrect and derisive introduction, she goes on to
place a large share of the blame for the motherhood mess on
attachment theory, which she blithely (and inaccurately) links
to bonding, attachment parenting, quickly moving on to the
recovery movement, and so forth. In her haste and anger, she
turns a complex literature into an object of ridicule. She mis-
quotes some of the great lights of the infant mental health
movement-Brazelton, Greenspan, and Spitz-taking their
work and their ideas out of context in a way that I found
utterly infuriating. She maintains that Spitz discriminated
against working mothers; although he may have once ven-
tured into this territory, his overriding and abiding concern
was for children raised by ever-rotating caregivers in barren
institutions after being traumatically separated from their
mothers. His teachings revolutionized the care of infants
in hospitals. This is but one of many examples of enormously
distorted scholarship, all used to buttress her argument that
women have been unduly harmed and tormented by the
emphasis within attachment and psychoanalytic theories on
the importance of the mother–child relationship. Feminism,
too, is likewise simplified and misrepresented as ‘‘all about
performance and control’’ (p. 46).
As a woman who has spent her entire professional life
working in the field of attachment theory and research,
I am stumped; how does a theory that values the mother’s
importance in the development of the child’s mind and spirit
lead to women’s feeling that they must be focused on their
child each and every moment of the day? I have never read
anywhere that mothers should give up their inner lives (to the
contrary, in fact), give up on their relationships with their
partners, dress up in overalls, and decorate their homes in
brightly colored plastics. Warner fails to read the theory with
any complexity whatsoever; separation and autonomy are the
outcomes of a secure mother–child relationship, not the in-
sanity she describes.
Even more disturbing than these kinds of overgeneraliza-
tions is Warner’s failure to consider that women make these
124
Copyright 2006 © American Academy of Child and Adolescent Psychiatry.
Unauthorized reproduction of this article is prohibited.
choices for their own reasons. I don’t think that mothers be-
came ‘‘control freaks’’ as the result of the evils of attachment
theory and feminism gone awry. Mothering is a complex, dif-
ficult, enterprise; the ‘‘mess’’ she describes is one response to
it. Warner suggests that it is the rare upper middle-class
mother who doesn’t feel driven and overly ambitious. In
my experience, some mothers feel this way and others don’t,
with many permutations in between. She completely over-
looks the mothers (just as common in my experience) who
use various societal trends to justify neglecting their children
while they tend to their own needs. The kind of overinvest-
ment she describes is an individual difference, and not all
women are prey to it. My own sense, based on clinical as well
as personal experience, is that the women who get into these
jams do so for a complex array of reasons: feelings of inad-
equacy and competition, displaced ambition, and unresolved
losses and traumas. It is hard for women to spend years pre-
paring themselves for professional careers only to have little
outlet for their drive, competition intelligence, and ambi-
tion; for some, their children and their children’s develop-
ment become the vehicle whereby to reassure themselves
that they are living meaningful and whole lives. But moth-
ering, as so beautifully described by de Marneffe (2004) in
her eloquent book on mothering, Maternal Desire: On Chil-
dren, Love, and the Inner Life (reviewed in the February
2005 issue), emphasizes different sorts of less tangible
pleasures and distractions, among them the development
of a person and of a relationship. Warner also fails to con-
sider how damaging such overinvestment is for children,
who end up feeling both neglected and precious as a result
of this kind of hothouse parenting. This is not what any
reputable or thoughtful child development experts had
in mind when they focused on the importance of the par-
ent–child relationship as a foundation for capacity for the
child’s capacity to love and to function independently.
Warner notes that ‘‘there is a kind of mental allergy to
talking about external causes’’ (p. 56) for this perfect mad-
ness. In her failure to look at the complexity of women’s
internal experience, namely, the feelings and desires that
sometimes cause them to act in ways that make little sense
and are often not good for them or their children, Warner
betrays a different kind of mental allergy. We need a deeper
understanding of the internal complexities of motherhood,
of how difficult and fraught it is for women to balance dif-
ferent aspects of themselves in dynamic and meaningful
ways against a backdrop of a society that rarely supports
flexibility and fails to embrace complexity. We need a level
of thinking that will help women discover the solutions that
can flow from such internal and external complexity and
that can truly change the way they experience themselves
in relationship to mothering. What we don’t need is a dia-
tribe against theories and practices that in point of fact
J. AM . ACAD. CHILD ADOLESC. PSYCHIATRY , 45 :1, JANUARY 20 06
 B O OK R EV I EW S

affirm mothering and autonomy; a diatribe that effectively

throws both the baby and the mother out with the prover-
bial bath water.
Arietta Slade, Ph.D.
Doctoral Program in Clinical Psychology
The City University of New York
New York
DOI: 10.1097/01.chi.0000186450.49579.43
Disclosure: The author has no financial relationships to disclose.
de Marneffe D (2004), Maternal Desire: On Children, Love, and the Inner
Life. New York: Little, Brown
Slade A (2005), Desire: On Children, Love, and the Inner Life, by Daphne de
Marneffe (book review). J Am Acad Child Adolesc Psychiatry 44:201
Note to Publishers: Books for review should be sent to Andr
e s Martin, M.D.,
M.P.H., Yale Child Study Center, 230 Frontage Road, P.O. Box 207900,
New Haven, CT 06520-7900.

J. AM. ACAD. CH ILD ADO LESC. PSY CH IATRY, 45:1, JANUARY 200 6 125

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