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Book Review   |    
Harriet P. Lefley
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.12.1823

by Marti Leimbach; New York, Doubleday, Nan A. Talese Books, 2006, 288 pages, $22.95

Dr. Lefley is a professor in the Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine.

An elegant, insightful novel, Daniel Isn't Talking is about raising an autistic child. The experience is one of inordinate pressures, conflicting treatment approaches, disturbed households, and family conflict. The protagonist, Melanie, an American in London, marries an Englishman who is the man of her dreams. The birth of their children, Daniel and Emily, fulfills their dreams. But soon the mother knows something is wrong with Daniel, while the husband persists in denial. The couple fights. The husband withdraws. The marriage sours. A fashionable, carefree young woman becomes a frumpy, obsessive caregiver.

This is not a new story. In fact, it is fairly typical when there is mental illness in the family, especially when it involves the unfathomable behavioral disorder of a child. Autism is particularly trying for parents. It is difficult to treat and yields little of the human reciprocity that people expect and need from those they love. And it offers an unpromising future for too many children who, with appropriate resources, may actually be capable of leading productive lives.

Not too long ago, "refrigerator parents" and hostile mothers were blamed for causing this condition in their children. The existential wounds were painfully salted by our putative helping professions. Clara Park, mother of an autistic child, once described, "a kind of pain that only those can understand who have lived it, an assault on the most fundamental of animal instincts, the desire to benefit the young creatures one has brought into the world" (1).

This book expresses that pain. It unfolds against a background of now-discredited etiological theories and their effects on a mother crazed with the stressors of incomprehensible behaviors, controversial professional advice, minimal support, and irrational guilt. She rages against child psychologist Bruno Bettelheim and charges him with "a humanitarian crime" in his accusations of maternal rejection. Here is a devoted, loving mother who yearns to interact with a child incapable of interacting. Her agonized attempts to cope with his frantic insistence on sameness of objects and rituals, his perseverating behaviors, and his frustrated head banging are graphically portrayed. Melanie desperately tries to understand Daniel's inexpressible needs, to please him, to stop his uncontrollable tantrums, and at the same time not to shortchange the normal sibling vying for her attention.

Considering all this, the author cleverly depicts the parents as the classic duo of overinvolved mother and distant father, who have dual family histories of human losses and clinical depression. Reflective of too many case histories, we are offered rich but irrelevant psychodynamic material with no evident specificity for the diagnosis in question. This is real-life stuff.

After multiple assessments and trials, Melanie finally discovers a firmly dedicated behavioral therapist. Daniel learns how to speak and even play with others, and the mother's choice is vindicated. We have seen this mother in the clinic and the academic literature. She refuses to accept guarded prognoses, pesters professionals for reassurances they cannot give, reads widely, tries every conceivable traditional and nontraditional therapy, and essentially devotes her life to seeking an elusive cure. She is an annoyance, a royal pain to staff. Treasure her. In her obsessive commitment and zealous search, she just might find the resources that open a life for her child.

Park CC: You Are Not Alone: Understanding and Dealing With Mental Illness. Boston, Little Brown and Company, 1976
 
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References

Park CC: You Are Not Alone: Understanding and Dealing With Mental Illness. Boston, Little Brown and Company, 1976
 
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