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This ambitious book presents the summarized results collected over ten years of the Early Natural History of Childhood Psychosis Project conducted by the authors who are affiliated with the San Francisco Psychoanalytic Institute. The focus of the book is on the authors' study of children diagnosed as having psychotic disorders in the first four years of life. The children were studied from a varied frame of reference incorporating psychoanalytic, cognitive developmental, descriptive psychopathological, and family dynamic points of view. On a larger scale, the authors are attempting the very ambitious task of integrating in the study of psychotic children a psychoanalytic frame of reference with those of academic psychology and descriptive psychiatry. This is a task, advocated by some (Lewis, 1981); but undertaken by few within mainstream psychoanalysis. As will be seen, the results, like those of many similarly ambitious tasks, are mixed.
The first four chapters of the book involve a comprehensive and thoughtful historical review of the study of psychosis in childhood (Chapter 1); the diagnosis of childhood psychosis, largely as practiced today (Chapter 2); and normal development of the earliest mother-child interaction, incorporating findings from academic developmental psychology (Chapter 3); and the internal mental development of the child, largely from a psychoanalytic viewpoint (Chapter 4). The focus of the chapters on development reflects the focus of modern research on the qualities of the field of interaction between caretaker (mother) and child, rather than on either party as an isolated unit. It is this field of interaction which is the focus of the study.
While the first four chapters cover their subject area comprehensively and thoughtfully, one area was notably and conspicuously omitted from the discussion: how one defines conditions as “psychotic” in children four years of age and younger in whom both communicative skills necessary to convey this most ab