Paris: Presses Universitaires de France,
Collection Fil rouge; 2010.
1. Edition. Broché, 272 pages.
Prix Euro 29.–.
ISBN 978-2-13-058429-2.
One generation after the pioneers of child psychiatry (Spitz, Mahler, Winnicott, Bowlby, M. Klein, A. Freud, etc.), clinical researchers in Geneva, Switzerland (Cramer, Manzano, Palacio Espasa, Knauer and collaborators) present the results of their research and therapeutic efforts covering several decades. They offer unparalleled evidence, understanding and perspective. Several cultural and political factors contributed to such exceptionally fruitful development of the child psychiatric institutions in one city. I wish to name only two of them: the unified political leadership by one of the child psychiatric medical directors in both educational and health politics, and the close collaboration between paediatricians, child and adult psychiatrists and psychologists.
One of the many books that have resulted from this is the one presently reviewed; it is based on a prospective study (Knauer D. Med Hyg. 2002;60:1734–8) of a cohort of babies who were treated in a day hospital (“Jardin d’enfants thérapeutique”) for 17 months on average during their early childhood (2–4 years). The book can be used as a textbook of child psychiatry due to its profound discussion of psychopathology and treatment. There is a useful appendix giving details of the treatment methods offered at the day centre and the diagnostic tools used. The children vary widely in the severity of their condition but, since a day hospital setting was indicated, they all present rather severe psychopathologies. Encouraging evidence provided by the book is that if adequate treatment is provided, the prognosis for behavioural disturbance is not as bad as generally believed.
The multifocal approach consists of psychotherapeutic and psycho-educational measures comprising of stimulation for emotional sharing, symbolic activities favouring attention and reflection in the small child, integrated psycho-motor, speech and psychotherapeutic treatment, including individual psychoanalytic and cognitive-behavioural techniques and mother and/or fatherchild therapies, and family and parent sessions in individual, couple and group settings (p. 236).
The book omits cases involving the child being placed outside of the family. The authors say (p. 13) that the child is “inserted in his familial environment and being cared for from the start; he depends on this as if it were nurturing soil, “more or less fertile”. We should bear this in mind for extra-familial placement is frequently, and often systematically, practised when the environment seems to be a risk factor.
The book is recommended for experts and students, and it should be translated into other languages: such as English, German, Italian, Spanish and Chinese.
Thomas von Salis, Zollikon
