Medical records of psychiatric patients rarely reveal the trials and outcomes of attempted preventive strategies in premorbid stages. We now have numerous memoirs, by both patients and family members, of life events that preceded and influenced the onset of severe behavioral disturbance in formative years. Among these, the school atmosphere, the behaviors of exasperated, confrontational teachers, and bullying peers were often a trigger for decompensation of a vulnerable child unable to live up to age-defined expectations.
This book deals with the author’s son Joseph, who as a toddler manifested preferences for female toys and clothing. His liberal parents, assuming that he was likely to be homosexual, willingly accepted his orientation far sooner than the child was willing to acknowledge it. As the author himself states, research indicates that a majority of gay children do not develop psychopathology. Yet a great deal of the narrative focuses on denial of sexual identity as a major indicator of inner turmoil that affected the cognitive development and school performance of a talented child. Joseph was variously diagnosed in school records as having “learning disabilities, Asperger’s, ADHD, sensory integration dysfunction, oppositional defiant disorder, bipolar disorder.” With frequent suicidal ideation and at least one failed attempt, Joseph would have tried to end his life in a panic were it not for concerned parents seeking and finding accepting peers. Even well-meaning school systems and competent psychiatrists cannot provide the therapeutic experiences of a welcoming social group.
Essentially, this is a story about prevention. The author, a national correspondent for The New York Times, writes a well-documented book that integrates current research with a personal story of a troubled child, an inadequate school system, and the efforts of one family to assemble the resources needed to keep prodromal symptoms from becoming full-scale decompensation. The book ends on a high note, with drawings by Joseph and a clear acceptance of his sexual identity after salutary group and camp experiences with gay peers. But the therapeutic interventions and happy ending were effected by caring parents who found resources outside of the educational and mental health systems. Overall, this is a measured account of the damage schools can do, the constraints under which they operate, and the need for an alliance of parents, educators, mental health professionals, and concerned advocates to ensure optimal treatment resources for vulnerable youth in the fragile prodromal years.
Acknowledgments
The reviewer reports no competing interests.