Book Reviews 372

learning and action related? Is it defense against the tendency to act that leads to learning problems? If so, how? And so on and on.

The symposium is rich, and the monograph is recommended reading for everyone interested in the area. But the impact of the study is one to demand of us ever wider and more inventive explora- tion of our elementary concepts.

EARLY CHILDHOOD DISTURBANCES, THE INFANTILE NEUROSIS, AND

THE ADULTHOOD DISTURBANCES: PROBLEMS OF A DEVELOP- MENTAL PSYCHOANALYTIC PSYCHOLOGY. By H u m berto Nagera. MONOGRAPH SERIES OF THE PSYCHOANALYTIC STUDY

OF THE CHILD, NO. 2. Foreword by Anna Freud. New York: International Universities Press, 1966, 96 pp., $3.00.

Reviewed by Aaron H . Esman, M.D.

The publication of T h e Monograph Series of the Psychoanalyf ic Study of the Child has been greeted with universal satisfaction. The high standards of scholarship and of clinical and theoretical sophistication characteristic of the articles contained in the annual volumes of the Study have aroused the expectation of similar levels of achievement in the extended monograph form. And the announcement that the initial monographs would deal with aspects of the research work done at the Hampstead Clinic has led to particularly high hopes, which were, in large measure, rewarded by Monograph No. 1 on the appli- cation of the Hampstead Index to a specific case study.

It is doubly distressing, therefore, to record one’s profound disap- pointment with the second of these monographs. Nagera appears to have set out to reconsider the relationship between adult psycho- pathology and its infantile determinants, and to reformulate child- hood diagnostic categories in the light of recent advances in ego psychology and developmental studies. The results of his efforts, though no doubt of value to himself in clarifying his own thinking,

Dr. Esman is Director of Psychiatric Training at the Jewish Board of Guardians, New York, and a Lecturer in Psychiatry at Columbia University. He is a member of the New York Psychoanalytic Society and The American Psychoanalytic Association.

Book Reviews 373

and perhaps of internal utility to the staff of his clinic, scarcely war- rant publication in their present form and under their present auspices.

Nagera has, apparently, only latterly become aware that we cannot, in the words of Anna Freud’s foreword, “subsume all childhood dis- orders under the all-embracing title of infantile neurosis.” Indeed, it is the main thrust of his essay that preoedipal factors are of major importance in determining certain forms of childhood disturbance. This will scarcely come as news to anyone who has spent any part of his time during the past twenty years working in a child guidance clinic, or to anyone who has read the contributions of Greenacre, Mahler, B. Rank, Fries, Erikson, Alpert, Goldfarb, Escalona, and many other workers on this side of the Atlantic-none of whose names appears in Nagera’s bibliography and only one of whom (Greenacre) finds a place in his text. Indeed, for one whose own medical education and psychiatric training were received in the Western hemisphere, Nagera seems to have a positive scotoma for work done west of Land’s End, let alone outside the framework of strictly psychoanalytic investigation.

Thus, pages are devoted to defending the proposition (surely no longer needing defense) that constitutional differences among inEants are a significant determinant of later development. Much, also, is made of the scarcely novel point that frustration may serve to promote as well as to retard early development. Nagera concludes with a graphic representation of a developmental-diagnostic schema, which is useful but does not begin to represent as comprehensive a contri- bution to the field of developmental nosology as the recent GAP Report on Psychopathological Disorders in Childhood. His discus- sion of the developmental disorders adds nothing to Anna Freud’s earlier observations on the subject.

I do not wish to create the impression that Nagera has produced a bad book, or one that is theoretically unsound, or one that may not be of some use to trainees in the early stages of their studies. He has, I fear, only produced a book that is unnecessary.