To the practicing clinician dealing
with individuals labeled learning disabled or attention deficited, there often
seems only two roads one can take. If
the diagnosis is suspect, one works to understand other, possibly more neurotic
causalities. This route is less accepted, being seen more as "blaming the
victim." The second is blind acceptance of the diagnosis and the
biological constraints of the disorder. The individual is, as she or he is,
because of the neuropsychological dysfunction. This route leaves the clinician
with an over-simplistic picture of the individual, almost as if one were
dealing with an organism of the single celled variety and not the complexity of
the more human kind.
Joseph Palombo takes a less
traveled path in his text Learning Disorders and Disorders of the Self,
one that attempts a space between the aforementioned two. Palombo makes no
attempt to argue against the various diagnostic criteria of learning disorders
and instead focuses on the ways in which these varieties of neurological
dysfunction challenge and often derail personality development. Taking a solid
self psychological stance (a variant of contemporary psychoanalytic thought
based on the writings of Heinz Kohut and focused on the ways individuals
develop and maintain a sense of self esteem), Palombo uses theoretical
constructs to map this third trail and guide the clinician who navigates it.
The text begins with an explanation
of Palombo's decision to undertake the writing of this book through a history
of his training and a very brief history of psychoanalytic theory in its
relation to child development. Palombo makes a useful sketch of past psychoanalytic
work with the learning disordered and a discussion of the history of the
disorders in general. Palombo then moves to the first of the three major
sections of his work: the ways in which disorders of the self occur in the
development of the child with a learning disability. Focusing on the context of
development, particularly the ways in which parental and/or social factors
assist the child in developing a self narrative (this being the implicit way
the child organizes his fantasies and expectations of his or her place in the
world), Palombo outlines the necessity of a coherent self narrative, the
consequences of an incoherent self narrative and the loss of self cohesion
(usually resulting in anxiety or depression) that results from disruptions in
narrative. The relevance of these concepts to learning disabilities is
illustrated by a variety of clinical examples.
Palombo's second section deals with
the major varieties of learning disorders and developmental difficulties. Each
chapter is organized along characteristics of the disorder, expected
developmental history, varieties of possible self disorders and recommended
intervention. Beginning with Dyslexia, Palombo moves from least problematic to
most debilitating developmental disorders. Along the way, he summarizes
relevant data and ties this together, through his clinical experience, with
self psychological constructs and clinical illustration.
The final section deals exclusively
with the role of psychotherapy with children suffering from learning
disabilities. Beginning from a place of caution (therapy must be indicated and
often may be unnecessary or even harmful), Palombo outlines the role of the
therapist, expectations of change, course of treatment and expected pitfalls
(called moments of disjunction by Palombo). He spends considerable time
outlining the ways parents and family could be incorporated in the treatment.
Palombo's text has a plethora of
strengths. His years of experience shine through, especially in the excellent
clinical examples. He writes in a clear, concise manner that verges on the
lyrical. The book is well organized, to be practical and used by the clinician.
Palombo also does an admirable job bridging psychoanalytic theory with
neuropsychological assessment. He does not shy from offering criticism of
either camp and, time and again, his empathy for the children in his care drive
him to criticize anything that complicates their betterment.
The weaknesses are really only
quibbles, though one does bear mentioning. Palombo relies almost exclusively on
a self psychological construct (almost is correct, since he does mention
several other relevant constructs) and, as a result, succumbs to the weaknesses
inherent in the theory. Though an accommodating environment is certainly important
in developing and maintaining self narratives and self cohesion, it would have
been interesting for Palombo to bring his considerable expertise to bear more
on the negative consequences of conflictual adaptation, to have him address the
self sabotage and self loathing that can disrupt development.
In conclusion, this is a remarkable
book and highly recommended to the practicing clinician or any interested
party. I suspect it would enrich the understanding and practice of both the
seasoned and novice clinician. Furthermore, it is written from a place of
compassion and a desire to heal.
© 2003 Dan L. Rose
Dan L. Rose, Psy.D. is a Clinical
Psychologist involved in direct clinical work and training at Columbus State
University and in private practice. His interests include psychoanalysis,
neuroscience, religion and literature.