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Book Reviews   |    
Exiting Nirvana: A Daughter's Life With Autism
Reviewed by Jeffrey L. Geller, M.D., M.P.H.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.9.1259
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by Clara Claiborne Park; Boston, Little, Brown and Company, 2001; 225 pages, $23.95

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In 1967, in a book titled The Siege, Clara Claiborne Park wrote an account of her daughter's first eight years, years in which mother and daughter learned to live together with the daughter's autism. In Exiting Nirvana, the sequel to that book, Park looks again at the life of her daughter, Jessica Park, who is now in her forties.

Exiting Nirvana provides readers with what is perhaps the best available description of autism from an observer's perspective and the finest exposition of a parent's decades-long experience with a child with autism. These reasons alone would be enough to make Park's account well worth reading, but her book offers much more than that.

Exiting Nirvana is the story of a mother and daughter's journey toward manufacturing personhood in an individual for whom being a person in an interpersonal and interactive sense is not a natural part of her being. Park not only describes the monumental efforts to achieve this end but also confesses her doubts, at different stages of Jessy's life, about the wisdom of the journey.

The book's title reflects the author's uncertainty about having embarked on this quest. Park wonders, "Is it not happiness to want nothing but what you have?" She wonders about her invasion of her daughter's world, "an abstract world of order, repetition, all that represented intelligibility, security, in the bewilderment of talk she could not understand, body language she could not read, social clues she could not interpret." Should she attempt to socially educate or maybe even program a child "to whom algebraic processes make more sense than the social interactions of Dick, Jane, and Sally"?

Park arrives at the answer to her question early in Jessy's life. On the whole her answer is in the affirmative. The doubts, however, have never entirely dissipated.

The reader is taken along, through travails, trials, and tribulations, to observe the virtual transformation of Jessy Park as she emerges from her self-contained, orderly, isolated world to become an individual who learns through explicit, didactic instruction and repetition to have usable language, to recognize—but not really ever to read—social cues, to learn social phrases, to experience pleasure, and to experience hurtfulness and loss. Everything must be taught by her mother—and others who move in and out of Jessy's life, most notably paid companions—and everything must be learned by Jessy.

Nothing about being communicative or socially interactive in the world comes naturally to Jessy. "But words are available now," Park writes, "preassembled, replicable, reliable. Like maps, like charts, like calendars, like schedules, all of which she could read easily before she could read text, they allow her to lay hold of her experience, bring it under the mind's control." Park was trying to teach her child that the world is ever changing, that all interactions are filled with nuances, but her pupil "wanted the world to stay still, needed it to stay still, because if it would only stay still she could understand it."

Mother as teacher needed to understand daughter as pupil—not at all an easy task. As Park points out, "For Jessy, things are what they are, and if they have meanings, they are wholly idiosyncratic. To understand her is to understand that." So while mother is teaching Jessy to communicate with her so that Jessy can communicate with others in the world, mother is often at a loss as to what Jessy is communicating to her when Jessy is using her language, not mother's. Frustrations abound on both sides. This perpetual quagmire exacerbates whatever the cognitive incapacities are in an individual with autism and contributes to making all learning rote learning.

Exiting Nirvana chronicles a success story. Jessy Park has become an accomplished artist (her work is on the cover of this issue of the journal; also see her Web site at www.jessica park.com); she is employed full-time in the Williams College mail room; she manages parts of her day-to-day life while living in her parent's home; and she contributes in useful ways to family life. She can perform, but can she interact? That remains Park's question even at this point in her daughter's life. Park observes, "Thinking of others, of course, is hard when you don't have a 'theory of the mind' to allow you to see something from another point of view. Even in the unemotional, physical world, Jessy can't do this." But the possibility that she can is there at the end of Exiting Nirvana, and perhaps in a future book that chronicles the next 20 years of Jessy Park's life, we will read about how empathy was learned.

Exiting Nirvana is an extraordinarily well-written, moving account of a mother's struggle not only to bring her daughter into the world but also to teach her how to have an ordinary life. Park writes, "These days, however, most of her discouragements and satisfactions are like those of other people—less interesting to read about than the joys and anxieties of her private universe, yet reassuring in their very ordinariness." At the same time, Park and the other family members have come to appreciate Jessy's uniqueness. "We realize we no longer even dream of the triumphant emergence into normality, we no longer even want her to exit Nirvana all the way. In a development we never could have envisaged, it looks as if she, and we, can have it both ways."

The readership of this book is virtually the universe of readers. Anyone interested in child psychiatry should grab this book immediately. Any parent of a special-needs child of any kind will glean much from this book. Anyone interested in existential questions of being can learn from Clara and Jessy's journey together. I would make this book required reading in the curriculum of every discipline in the mental health field.

I end this review on a personal note. I had the opportunity, when Jessy Park was about 11 years old, to spend time with her, to observe her, and to learn from her, when I was a Williams College psychology major. So I can tell you that, if anything, Clara Claiborne Park is modest in her description of the scope of the tasks presented to her and of the accomplishments she and her daughter have made. But there is a stability to autism and a certain immutability to the unnaturalness of the social connectedness in those with the disorder. While reading Exiting Nirvana, I asked my son, Jesse, a Williams College freshman who goes to the mail room regularly to pick up his mail, if he knew Jessy Park. I told him she works in the mail room. He told me he did not know her. I told him she has autism. He immediately said, "Oh, I know her." "Jesse," I asked, "you didn't know her when I told you her name, but knew her immediately when I said she had autism; how is that?" His response: "Everything she says sounds rehearsed." As Clara Claiborne Park brilliantly points out, so it is, so it is.

Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical School in Worcester.

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