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Valerie Sinason's book is an exciting, if somewhat uneven, introduction to providing psychoanalytically informed treatment with intellectually disabled people. Sinason earned her Ph.D. in Trauma and Disability, and became an analyst since the first edition of her book in 1992. She is refreshingly transparent about her awareness of her own handicapped thinking about people who are different. Like the sociologist Erving Goffman (1963), who writes about stigma as “the process by which the reaction of others spoils normal identity,” she has a layered concept of disability. Her discussion of the problem of nomenclature for people with disabilities describes euphemisms and their role in distancing us from those with disabilities, as well as the inevitability of every new diagnostic term becoming contaminated, and ultimately politically incorrect as time goes on. She recognizes that this is not truly a problem of nomenclature, but a social problem, and kept her title of “Mental Handicap” in defiance of traditional attempts to find more hygienic terms, although she admits to softening the title with her subtitle “an analytic approach to intellectual disability.”
She begins her discussion by noting two central themes: the first is what she terms the secondary handicap, that is, the person's psychic response to experiencing their own handicap. The second addresses the notion that beyond the actual handicap that may be measurable in some way lies the very human wish to deny such handicap. One way to do this is to numb ones' self to the grief of feeling different or deficient. In this context, Sinason reminds us that stupid means, “numbed with grief” literally, to stupefy. All of us can become numbed with grief or “stupid” in not understanding one another in times of extreme stress, that is, we all utilize denial when reality becomes unbearable.
Sinason offers an incisive analysis of the ubiquity of the handicapped person's smile. At first she assumed, as so many of us do, that t