by Joel Paris
Review by David J. Mullen, M.D. on Dec 5th 2001
This work by Joel Paris, MD, Professor of Psychiatry at McGill
University, appears in some respects to echo some of the positions taken
in Judith Rich Harriss controversial 1998 book The
Nurture Assumption. Unlike Harris, however, his perspective is
that his of a highly regarded and experienced clinician and as such his
arguments addressing clinical issues are delivered with greater authority.
Both books present considerable challenges to the long-standing assumption,
taken by both mental health professionals as well as the lay public, that
childhood experiences generally and those of early childhood in particular,
play an especially critical role in the development of the adult personality.
Like Harris, he presents data undermining the notion that subtle nuances
of parenting can result in significant psychological damage to the majority
of children. His evidence-supported argument contends rather that the majority
of children are quite resilient even in the face of major stresses with
only a minority developing significant psychopathology. Even then
the stresses that seem to be most closely associated with pathology are
not single events in most cases but events that recur frequently over a
long span of time.
However, despite the emphasis on resilience, he does acknowledge the
concept of vulnerability both to trauma as well as parenting technique.
The data from Jerome Kagans study of inhibited children and the impact
of differential parenting is given as exemplifying such vulnerability.
It is this last point, the existence of relative vulnerability, that is
subsequently elaborated into an argument that genetically based temperamental
factors are key elements to understanding the relative risks for developing
psychopathology. In addition, I feel that it is here, in his appreciation
of individual vulnerability that Paris clinical experience and knowledge
are most clearly advantageous. He states most clearly that the impact of
parenting should not be under-estimated and certainly cannot be dismissed.
Rather he seeks to define his efforts in the present volume as seeking
to counter-balance strong historical trends toward discounting the significance
of temperamental and biological factors in personality and psychopathology.
Again, environmental factors are not discounted but are seen as less critical
than is commonly perceived, especially with regard to the role stressful
events in pathology.
The author focuses a good deal of criticism on two schools of clinical
work: 1) psychodynamic/psychoanalytic and 2) recovered memory based therapy.
Both are censured for an excessive reliance on the primacy of childhood
assumption as well as for depending too much upon clinical inference rather
than empirical data derived from controlled studies. In addition,
recovered memory approaches are strongly criticized for ignoring an increasing
body of such empirical information regarding the formation of memories
and the reliability of recall under the influence of suggestion.
Finally, Paris echoes the concerns of many regarding harm that numerous
individuals and families have suffered as a result of abuse accusations
stemming from eager therapists seeking for evidence of abuse/neglect in
all of their patients.
I think one could make a case that Paris is overstating his case somewhat
regarding the relative insensitivity of the personality to environmental
events in childhood and the relationship of such events to psychopathology.
First, the variables described tend to be of the rather broad variety (Five
Factor Model, Cloningers dimensions of personality, etc.), rather than
the more specific personal idiosyncrasies of interest to the psychoanalytically
oriented clinician. Secondly, the threshold Paris is utilizing
for diagnosing disorder is not completely clear. Presumably he means
DSM criteria are met but the clarity and consistency of use of the DSM
are not without problems and controversy, particularly from a depth psychological
perspective. Paris does acknowledge that childhood maltreatment may
result in distress, but the line between distress and disorder is not
always so well defined. Most persons enter treatment because they
are in distress not because they have learned that they meet specific formal
diagnostic criteria. I suspect the authors zealotry may be explained in
part by the authors former commitment to psychoanalytic models of pathology
However, despite this limitation and on the whole, this book is well
written and well balanced. Empirically supported, data is effectively
marshaled in favor of his position that childhood primacy in the development
of personality may be less significant than has been thought and the centrality
of traumatic events may be substantially less critical than most persons,
lay and professional alike, may believe.. Despite I therefore recommend
this thoughtful work to anyone interested in the relationship between child
development and psychopathology.
© 2001 David Mullen
Mullen is an Associate Professor of Child and Adolescent Psychiatry
in the University of New Mexico School of Medicine. He is the Deputy Medical
Director of the UNM Children's Psychiatric Hospital and attending physician
in that facility's adolescent inpatient unit. His interests include the
application of evolutionary psychological principles to the understanding
of child and adolescent psychopathology, especially the disruptive behavior