Book Review
General Psychiatry
Myths of Childhood. Joel Paris. Philadelphia: Brunner/Mazel; 2000. 227 p. US$34.95.
Reviewer
rating*: Excellent
Review by: David S Goldbloom, MD, FRCPC
Toronto, Ontario
Joel Paris has written—again—another lucid, synthetic, and provocative book that challenges fundamental assumptions that have dominated our field in the last century. A self-acknowledged gadfly and devotee of evidence, he has a simple but mammoth goal for this book: “to show that the idea of primacy of childhood is wrong.” To accomplish this, he critically examines the evidence—or lack thereof—that underlies 3 beliefs that underpin classic psychodynamic understanding: 1) personality is formed by early childhood experience, 2) mental disorders are caused by early childhood experience, and 3) effective psychotherapy depends on the reconstruction of childhood experiences.
This is not a radical deconstructionist or antipsychiatry approach. Paris writes with years of experience as a psychodynamically informed clinician and therapist, as a keen observer of the culture of psychiatry, and as a believer in the value of psychotherapy (based on evidence). He writes not with antipathy but with humility. In fact, the section entitled “Why Therapists Are Not Experts On Life” describes what we really know vs what we are prone to believe. He notes that “psychotherapy has an intrinsic tendency to validate its own theories.” This observation is hardly unique to psychotherapy and might well be said of biological psychiatry and perhaps all systems of knowledge. He compels us, however, to examine more critically the evidence for some core assumptions that pervade both theory and everyday clinical practice.
He begins with a necessary tour of clinical epidemiology and consideration of our relentless need for attribution of pathology. He asserts clearly the recurring findings of others: the most common outcome of adversity is resilience rather than suffering or formal disorder. He critically examines the extent to which epigenesis as reflected by Freud, Erikson, and Piaget, while intuitively appealing, is supported by data. This section includes some barbs tossed toward psychoanalysis, the concept of repression and recovered memory, and attachment theory. He manages to summarize a vast literature on behavioural genetics, contemporary models of personality and its origins, and aspects of psychotherapy and outcome. A firm proponent, like most modern personality researchers, of a dimensional approach to the understanding of temperament and personality, he provides compelling clinical examples of how formulation works when one moves into a theoretical frame that is more evidence-based than are classic psychodynamic ones.
Inevitably, such a broad sweep of a vast literature invites a critique from researchers and practitioners whose life work may be summarized in a page or 2 of this crisp book. There will and should be counter-arguments to the stance that Paris has taken against the primacy of childhood. He would likely welcome the debate, if the ground rules include the burden of proof through evidence.
This book meets its mandate with a sweeping review of the literature and with references that are current to the year of publication. Paris, an internationally acknowledged researcher about personality disorder, draws on his own research and predominantly on that of others. As with his previous books on the origins of personality disorder, psychotherapy of trait dimensions in personality disorder, and nature and nurture in psychiatry, he writes in a highly accessible, carefully structured, and wonderfully integrative style. The book is both reasonably priced and well laid out.
This book will annoy some people. Some will dismiss it as an overly glib reduction of or barely veiled aggression toward a still-dominant conceptual and therapeutic model. I suspect the author’s mission would be accomplished if he riles unswerving practitioners of dogma and stimulates students to question traditional concepts and shibboleths. This masterful book deserves to be read by both these groups and would serve as a marvelous catalyst for discussion and reflection.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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