Increasing Awareness of Child and Adolescent Mental Health

This is the 18th in a series of volumes sponsored by the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). The series began in 1970, with a volume edited by James Anthony and Cyrille Koupernik, and for more than 30 years it has reflected the psychoanalytic orientation of its first editors. More recently, the focus has shifted, with a volume on evidence-based approaches (2006) and one on culture and conflict (2008). The title of the current volume gives few clues to its content (Is “increasing awareness” a fact or a goal?), but this volume builds on the previous one, including articles from around the world, from several cultures, and with a focus on the effects of political change and conflict.

This is not a volume to be described as required reading for the trainee psychiatrist or those who need to restrict their reading to material necessary for passing exams. It is, however, of considerable interest to those with time to expand their horizons, both geographical and ideological. Geographically, there are chapters on acupuncture as a treatment for autism in Hong Kong, the development of child mental health services in Eastern Europe, the impact of the one-child only policy in the People's Republic of China, and the shift from internalizing to externalizing problems in Japan. Ideologically, some chapters are solidly within the current empirical framework (psychopathology and service utilization, trends in the prevalence of autism), while others reflect the strength of the psychoanalytic tradition in child psychiatry. In particular, Jean-Yves Hayez's chapter “An Historical Approach to the Discovery and Promotion of Child Mental Health” may well open the eyes of psychiatrists recently trained in the United States and in the United Kingdom to the strength of other therapeutic traditions.

If I had to pick one chapter that I found to be the most interesting, it would be “Development of Child Mental Health Services in Central and Eastern Europe,” by Dainius Puras and Robertas Povilaitis, both from Lithuania. This chapter brings out how many aspects of a service system—aspects that those inside the system can easily take for granted—arise from the political history of the country. The authors point out that child psychiatry in Central and Eastern Europe had its origins in the biologically-based disciplines of neurology and “defectology.” The children diagnosed in this system were seen as a drain on the economy, and parents were encouraged to place them in state-run institutions, since “state policy was based on the model of social exclusion of vulnerable groups” (p. 257). This centralized system produced enormous amounts of careful documentation, and for outpatient services the polyclinic provided a range of relevant services. Thus, in some respects the service system could be compared favorably with that in other industrial countries. The authors argue, however, that the system paid no attention to the family or community environment and by extension ignored both prevention and promotion: “If mental health problems were supposed to only have a biological base then there was nothing to promote or prevent” (p. 258). The impact of United Nations and European Union policies and programs on the service system in Lithuania is an uplifting example of how things really can change.

My main concern with this volume is that there is no account of why these particular topics and authors were selected. One may infer that the chapters are based on presentations at the 2010 IACAPAP meeting in Beijing, but there is no description of whether these particular chapters were invited, or selected from other submissions, and by what criteria. In summary, the book contains a smorgasbord of chapters that will, I hope, increase the reader's appetite for some new flavors.