Friday, February 27, 2009

Images of Madness

Many years ago I had the pleasure of encountering Psychiatrist Sandar Gilman's books, Seeing the Insane (1982) and Disease and representation: Images of illness and madness to AIDS (1988). This was the beginning of what has become for me an obsession with how mental illness, medical, mental health & academic experts, science, and 'the self' have been reflected (projected?) in the arts and popular culture. Later, I discovered that there is an academic discipline that houses persons with similar preoccupations, Culture Theory.

One of the less admirable delights furnished by this arcane interest comes from learning how little awareness psychologists seem to have of the relationship between popular imagery and science. In an attempt to whipe out of my smugness, I am going to post some of the imagery provided by Gilman as well as those I've hunted down myself. I want to popularize popular culture's views of psychological (scientific) matters, as it were.

Images of Insanity, according to Gilman, began to show up during the Middle Ages with such stable features that a veritable iconography for the appearances of persons living outside the boundaries of sanity at the time. These were the Maniac, the Possessed, the Wild Man, the Melancholic, and the Holy Fool.

To those living in medieval Europe, madness was conceived of as a primitive power of revelation capable of upsetting the fragile illusion equilibrium and exposing the terrible perils, desolation and evil that riddled the world.

The wild man resembled an animal more than a human, which secured him a place outside of the higher realm of humanity. He carried a stick, like the Fool, and represented the chaos, isolation, and rootlessness viewed as an anathema to denizens of medieval European towns, villages and rural hamlets.

Madness was understood to bridge the world of appearances in which people lived their lives with all that was sinful, monstrous, inhuman, and unnatural. This realm of nightmare was accessible as temptations to sin, coming to the sane in dreams. The visions of madmen were the dreams of the rest of humanity. The growing preoccupation of Europeans in the late middle ages and early renaissance came in part from their experiences with the decimation and physical horrors of the Black Death, or Bubonic Plagues.
The painting on the left is a wing from the amazing Isenheim Alter, painted by Matthias Grünewald. It is called the Temptation of St. Anthony. Anthony is being tempted by everything that is eval, inhuman and unnatural. Note the Bubonic plague victim in the lower left corner. Parenzano's Temptati from 1492 is another temptation example.

Gilman claims that the renaissance portrayals of madness (and temptation) reflect the perceived threats and secrets in the world.

In the late 15th century, madness became a kind of "deja-la" of death. Foucault wrote, "It is the tide of madness, its secret invasion, that shows that the world is near its final catastrophe; it is man's insanity that invokes and makes necessary the world's end" (Madness & Civilization, p. 17).

Hieronimous Bosch's Mad-Meg (Dulle Grete) was meant to instill fear of damnation in the viewers, and I find it hair-raising today. Meg, whose insanity is clear from the iconography Bosch includes (the staff & bladder--see below--, her movement or traveling stature,and other oddities in her apparel). She is surrounded by the terrible world she represents.

Images of madness appeared in special relationships to Christianity. Sometimes the mad were believed to have unique access to holiness or divine messages. This may be a carryover from classical times when the oracles in that pantheistic context were typically delirious when channeling a deity.

On the other hand, the insane were also viewed as more susceptible to influences of the devil, requiring exorcisms to rid them of their demons. For example, the image to the left is a very old one of a saint expelling a demon from the man kneeling before him.

image on the right concerns the same theme: the woman on the right has been brought to some church setting to get rid of her madness/demon. The demon can be seen flying out of her mouth.Similarly, a saint is expelling demons from the man on the left.The demented or possessed also came to develop a special iconographic position that is evident in both of these above examples. The person suffering from possession is often held up by others as his or her head (and sometimes body) collapses backwards, arms stretched out rigidly on either side. In Raphael's Transfiguratio, in which Jesus ascends into heaven, a man whos is possessed is held up and pointed out by others as needing healing by the transfiguring god.

The same posture shows up in one of two etchings by Breugel of mad women being led away from their town. The woman on the right is raising her right arm somewhat, and leaning back into the poor man trying to steer her somewhere else than her home town. This picture also tell the story of the insane as increasingly homeless outcasts from their places of origin. This them of rootlessness will be taken up below with the theme, The Ship of Fools.

This is the position of frenzy, abandon, and loss of reason. We can find the same visual metaphor for submission to higher power for cure in the humanizing of asylums by Pinel, and then in clinic of Charot.

The image to below is a
propaganda-like painting of Pinel (for a new rational, humane treatment of the mentally ill) shows him freeing the patients of La Saltpetriere from their chains. His patient is a woman who assumes a position which both suggests her unreason, her vulnerability to patriarchial reason, and the taming of her dangerous sexuality. The association of madness with sexual wantoness, delerium, and women is not new, but took on great resonance in this context of morally righteous 'humane' treatments. The insane are also being freed from their shackles of exile, at least that was the hope. Mental illness was a moral problem, not a sign of demonic possession. Through reason, clean living, and moral training, most of an asylum's men and women could eventually return home; they had only to subject themselves to the authority of their doctor.

Later, we see this same figural relationship reappear in the imagistic pedagogy of French psychiatrist, Charcot, which took place at the same Parisian hospital. Freud spent a short time in attendance at Charot's seminars, many of which consisted of demonstrations by the master like that presented in the painting below.

This painting, commissioned by Charot, is the most famous representation of him: As the man we credit with starting the clinical/medical approach to psychology and with creating the first clinical research lab imbedded in a hospital rather than a university, this image of Charot instructing his students in the treatment of hysteria is iconic. The patient's pose, swooning with her breasts prominently in view, reflects her utter submission to Charcot's brillance. All the medical students are men; the only other woman in the room is a nurse from hysteria ward in Saltpetriere.

The painter, Paul Richer, painted himself into the center-rear of image, as well as his large, if faint, drawing of a woman in a cataclyptic pose from Charcot's
Iconographie photographique de la Salpêtrière. His drawing, which could be seen by every patient on Charcot's stage, is on the right.

Photographic Iconography of Salpêtriere consists of photographs taken by Bourneville and Regnard; most were made in a photographic laboratory created by Charcot for the purpose of documenting the diagnostic phases of hysterical attacks. The drawing of the woman on the left looks like our icon of possession; it was drawn by Richer from a photograph.

George Didi-Huberman in his fascinating book, Invention of Hysteria: Charcot and the Photographic Iconography of the Salpetriere, upacks the theatricality of his Tuesday morning lectures, as well as the performative demands of the setting. Didi-Huberman
is not alone in arguing that the "hysteria" that Charcot documented and demonstrated in his lectures was seldom found anywhere else. Freud was on to him.

The Iconography includes photographs of induced postures, brought about by a variety of hypnotic methods. The photograph of "Lethargy" on the right was prompted by a sudden flash of light.

The Holy Fool

One of the most common icons alerting the viewer to the troubled mental status of a human image, like the illuminated Psalm 52 on the left, was the presence of a staff or large stick, often with a bladder tied to its upper end. In evidence from the middle ages through the 17th century, a staff was to be found in the hands of all thought to be possessed by the Devil: fools, melancholics, witches, and madmen. The image on the left is called "A Witch and her Familiars," all of whom require staffs for identification. The cats, I assume we already know about witches.

Fools are widely scattered in medieval and renaissance illuminated texts. Most often the can be found in the minute decorations in the margins of a page--a search for fools in these contexts can be quite entertaining.

Music and dance are also incorporated into images of fools, folly, mania, and madness. The trope of Dancing Fools or Insane can be found from the middle ages up into the 19th century. I've inserted two examples:

Below is another images of a fool with staffs; this one is facing Death:

The painting on the right by Hieronimous Bosch is of a theme popular during the northern Renaissance, A Ship of Fools. While everyone on this ship of fools is intended to be a fool, Bosch also made sure that one of the figures had all the appropriate icons for the role: The seated figure on the upper right has a staff with a bladder at the end and a horned cowl. The cowl was associated with a monk's hood, but in the case of fools is marred by simulated, rather silly, devil's horns. The image to its left is a woodcut by Holbein, whose woodcuts illustrated Sebastian Brandt's widely popular book, Stultifera Navis, Das Narrenschiff, or The ship of Fools.

Rather than a state that mirrored the demonic consequences of humanity's sinfulness, Renaissance Folly came to mean flaws in an individual's moral character. The defects portrayed in the various ships of fools were those found in everyone, not just the mad. Fools lacked the tragic condition of the insane.

Perhaps only an
Idiot Fool (Holbein the Younger) would, because its doubled construction, qualify as irrevocably beyond the bounds of sanity, but that was hardly the case. Here, the fool is shown mocking death--his bladder raised to strike and his finger irreverently in his mouth. Meanwhile, death gleefully leads the fool off to the tune of dancing music played on his bagpipe.

And then, of course, there is the Educated Fool....Holbein's woodcut includes a feather-duster rather than a staff; perhaps that was the 15th century version of Ginko.

The Ship of Fools
also carries the theme of vagrancy and rootlessness, which was seen by the people of the Renaissance as flaws in character. This was a particular hardship of those seen as mad, for they were little tolerated in their communities and were sent drifting as beggars from place to place until they came more and more to be incarcerated--first into prisons along with imprisoned criminals, and then later into their own separated institutions.


Gilman describes how, at the beginning of the middle ages, the image of the melancholy
individual became the iconic figure of madness in general. One of the Four Humors, Melancholy represented an isolated life out of balance with the real world. Gibson includes a poem by the best-loved German poet of the thirteenth century, 

Walther von der Vogelweide, to demonstrate how the position of the body, as image, communicated a state of being we have come to associate as "internal." The state of the "self" described by the Minnesinger, Walther, would be readily understood as melancholic.

I sat down on a stone
And crossed my legs
And set my chin and cheek

In my hand.

Then I pondered very earnestly

How one ought to live one's life on earth.

I could not find the solution. 

from Gilman (1982) "Seeing the Insane"

Solis the Elder's (1514-1562) woodcut, Melancholicus, reflects an emblematic theme at the time; the numbing impact of the conflicts at that time between the humanism sweeping the continent and Roman Catholic tradition. The message is a negative moral judgment of melancholy: melancholy had the effect of paralysis and a state of tension due to a conflict between opposing powers, in this case between nature created by God and science made my mankind. 

Much more well known is the etching on the right, Melancholia I, by Northern Renaissance artist, 
 Albrecht Dürer, is one of my favorite works of art (which may give away my dominant Humor). The posture of the angel, pensive and darkened face, chin and cheek leaning heavily on her hand, exudes melancholy to the viewer, even those who do not know the title of the work of the iconography of melancholy. Her clenched and hidden hands suggest that she is ineffectual and her inactivity, in light of the many tools and recent scientific technologies surrounding her, can suggest the moral defect, sloth. The sleeping dog is also implies an inability to act. Finally, melancholy was associated with characteristics of passivity and excessive emotionality; e.g., the Feminine (Gilman, 1982).

The painting on the left from 1553 has the same iconography and the title is The Melancholy, painted by Lucas Cranach, a contemporary of Albrecht
Dürer. Here, too, we see the idle angel and sleeping dog, but the images of humanistic science are missing. The playful children may extend the idleness theme. In the background, inside a dark cloud, is the diabolical image of witches riding on goats and pigs. Cranach may be suggesting that melancholy was a state of suspension between two negative outcomes; the passivity of the indolent or diabolical delusions. The right path was to be found elsewhere. To provide a temporal context, Cranach was a friend to and painted a portrait of Martin Luther (1529).

Thursday, February 26, 2009

Social Justice Curriculum Review Proposal

I was charged by our curriculum review committee to develop suggestions for additions/revisions to our curriculum in order to expand and deepen our attention to the question of how social justice can be integrated into the professional practices of clinical psychologists. Before considering specific suggestions, I have found it important to compose an incomplete conceptual review on “social justice,” which could be fashioned into a framework for our department’s approach to the training students in the intersections of professional psychology and social justice.

It is my impression that, unexamined, these words, “social justice,” have come to be wielded as an ideological force in academia; reified into an instrument of self or group interests, the polemics surrounding the construct obfuscates the complex strata of meanings, implications, and contestations surrounding this relatively recent idea. These dynamics appear to lead to the suppression and marginalization of people and ideas not consistent with the unexamined ideology, and a paradoxically fascist system of stultified discourse and the façade of unified righteousness (on both sides of the polemic). One need look no further than our experiences as individuals and as a department in recent years, when we feel the terror incited by a facile, self-serving use social justice rhetoric; the effectiveness of this strategy was founded in its capacity to silence discussion and dialogue and to isolate and divide the community. And, we know from further experience, these practices continue into today. I invite us to wonder, then, what our students experience within our system as they relate to questions, to questioning, on issues related to social justice.

Constructing Social Justice
I propose that the construct, “social justice” at this time and place will never be reduced to a foundational, unitary meaning, neither by philosophers’ bests efforts nor by well meaning struggles for rational consensus. A review of the literature on the topic of social justice reveals unresolved, contentious philosophical and pragmatic theories within and between various disciplines, which for the most part precede psychology’s interest (Fraser, 1997; Fraser & Honneth, 2003; Habermas, 1984, 1990; Miller, 1999; Powers & Faden, 2006; Rawls, 1971; Sen 1999; Warnke, 1993). Social justice as a topic emerged in parallel fashion among twentieth century philosophers of justice and political science, as well as feminists and multiculturalists from various disciplines. Late in the century, discourses aimed at defining the parameters of social justice have spread to the social, health, and mental health and environmental sciences. The “linguistic turn” in the sciences, the intersections of multicultural theories with identity politics, the collapse of socialism, postcolonial developments, and globalization have all contributed to the immediacy and volume of multivocal calls for social justice in academe. In disciplines such as ours, this historical intersection of social values with pre-existing scientific values heightens our awareness of the fragility of our normative frameworks and contributes to schisms.

In the next few pages, I will argue for a social justice framework that is politically egalitarian while also sensitive to the claims of the identity politics of difference (Fraser & Honneth, 2003; Powers & Faden, 2006), and for the protection of specific, necessary conditions for the construction of principles of justice for our time. Suggestions for curriculum changes will follow these arguments.

Engagement with the fascinating, multifaceted, and justifiably contentious literature on social justice reveals an ephemeral ideal, rather than a universal, stable or imminent law, one that is ever in the process of earnest fabrication by social beings (e.g., us) out of the stuff of (a) history, (b) economics, (c) politics, (d) values, (e) cultures, and (f) dreams (Habermas, 1984; Miller, 1999; Warnke, 1993).

Hermeneutically-influenced theorists on justice propose that appeals to justice or social justice must be adjudicated not on the singular basis of universal principles, but rather on the promise or actuality of dialogic negotions under conditions of equal valuation of voice and access for all stakeholders (Fraser, 1997; Habermas, 1990; Warnke, 1993). They propose that any rational understanding of the concept of justice requires, at minimum, engagement with (a) through (f) above; that is, reflexivity and active, unrestrained social debate of every person living under the effects that concept. In this post-foundationalist time, they assert that justice is only ever a temporary, incomplete, contextually-informed, negotiated heuristic, which can only be justified in democratic societies by means of ongoing processes of open debate and deliberation among its human creators (Fraser, 1997, 2003; Habermas, 1990; Warnke, 1993; Young, 1990, 2000). There are no guarantees that this conversational social construction of justice will not be dominated by those who are more materially, ideologically, and/or rhetorically powerful, which would thereby obstruct free expression and exclude less powerful or culturally consonant voices (Warnke, 1993). For this reason, Habermas and Fraser each inject their version of the requirement that, in order to be rational and productive, justice conversations be unrestricted and unconstrained by power differentials (open, free & equal) (Warnke, 1993). The current popular proliferation of dialogue practices can be viewed as timely emanations from social and historical context shared with these philosophical justice discourses (Cissna & Anderson, 1994; National Coalition for Dialogue & Deliberation).

Further, most philosophical discourses on justice attempt to grapple with questions of distributive justice. Indeed, no matter whether one believes that distributive justice should figure into our definition of a just society, there is research evidence suggesting a near universal abhorrence of the enormous global disparities between the poor and the wealthy (Powers & Faden, 2006). Frankly, there is no ignoring these global economic discrepancies today when considering issues of justice. For example, the significant global economic discrepancies have risen to the top of development agendas for United Nations (with its Millennium goal of eradicating poverty by 2015) and the World Health Organization (Herzman, 2009; United Nations, 2000). International research such as that published in the 2007 series from The Lancet, suggest that poverty breeds poverty; people living under economic deprivations are unable to develop the skills necessary for participation in a democratic society, emerging or longstanding (Grantham-McGregor, Cheung, Cueto, Glewwe, Richter, Strupp, & the International Child Development Steering Group, 2007; Sen 1999). APA’s Public Interest Directorate began the twenty-first century by securing the organization’s Resolution on Poverty and Socioeconomic Status, which, among other things, committed the profession to supporting “public policy and programs that insure adequate income, access to sufficient food and nutrition, and affordable and safe housing for poor people and all working families” (American Psychological Association, 2000).

Political philosopher, Nancy Fraser (1997), has argued that justice relies on changes that balance citizens’ needs for both “recognition” and “redistribution” and Her concept of recognition is embodied by what we have come to know as the expectations of achieving multicultural awareness and sensitivity to differences between and similarities within groups. A banner of movements of identity politics, recognition focuses on celebration and empowerment of oppressed groups. The theory of social justice developed by I. M. Young (1990, 2000) has had a strong influence on counseling psychologists’ conceptualization of social justice (Speight & Vera, 2004; Vera & Speight, 2003); Young’s model fits into the recognition category. However, the social justice implications of recognition alone tend toward balkanization instead of democracy, and recognition advocacy typically elide not only socio-economic differences but also cultural customs that are oppressive to subgroups within cultural groups.

With her pairing of recognition with Redistribution, Fraser revisits and reinvigorates the socialist emphasis on economic equality, arguing that a society that houses both extreme poverty and extreme wealth institutionalizes barriers to full participation in the democratic process for its members; it is the byproducts of economic deprivation that keep the poor cut off from the democratic promises of freedom, equality, health and happiness: (a) poor social, cognitive, and physical development; (b) poor educational resources; (c) poor academic and vocational potential; (d) increased risks for health and mental health problems; (e) inadequate access to services; etc. (Farmer, 2005; Grantham-McGregor, et al., 2007). In order to achieve the purpose of eliminating poverty, what is considered necessary is solidarity across cultural groups, regardless of differences in recognition status, which means putting unique group interests (identities) aside, if only temporarily. Historically, political efforts to promote redistribution as an objective has minimized or erased other oppressive kinds, and this is still a risk. These two constructs of recognition and redistribution, according to Fraser, are necessary procedures in the construction of a just society; however, they are also incommensurable, and dialectically instable (Fraser, 1997; Fraser & Honneth, 2003). Recognition and redistribution are each founded on principles of inclusion and equality of voice for all stakeholders in the dialogic construction of justice in a democratic society (Warnke, 1997).

Thus, I argue that an integration of some form of commitment into our curriculum might begin with a framework incorporating these two concepts of social justice, recognition and redistribution. We could argue that our diversity curriculum addresses recognition; what is needed to embrace our engagement in educating psychologists in social justice is the integration of principles of redistribution into the curriculum along with an introduction to the redistribution/recognition model, as well as other important works on social justice from within the social sciences and psychology. Still, Fraser’s conceptualization provides only a pragmatic framework (do not dictate an outcome) from which assure that (a) through (f), above, are considered. The other necessary component is the provision of multiple opportunities for active engagement in reflection and debate on (construction of) what social justice can mean in professional psychology.

American Psychological Association (2000). Resolution on poverty and socioeconomic status. Retrieved January 26, 2008 from

Cissna, K. N. & Anderson, R. (1994). Communication and the ground of dialogue In R. Anderson, K. N. Cissna, and R. C. Arnett, The reach of dialogue: Confirmation, voice, and community. Cresskill, NJ: Hampton Press.

Farmer, Paul (2005). Pathologies of power: Health, human rights, and the new war on the poor. Berkeley: University of California Press.

Fraser, Nancy (1997). Justice interuptus: Critical reflections on the ‘postsocialist’ condition. NY: Routledge.

Fraser, Nancy & Honneth, Axel (2003). Redistribution or recognition? A political-philosophical exchange. London: Verso Press.

Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B, & the International Child Development Steering Group (2007). Developmental potential in the first 5 years for children in developing countries. The Lancet, Volume 369, Number 9555, 60-70.

Habermas, J. (1990). Moral consciousness and communicative action. Cambridge: MIT Press.

Hertzman, Clyde (2009) World Health Organization’s Vision statement of the Knowledge Network for Early Child Development, Commission on Social Determinants of Health. Retrieved January 26 2009 from

Miller, David (1976). Social justice. Oxford: Clarendon Press.

Miller, David (1999). Principles of social justice. Cambridge, Massachusetts: Harvard University Press.

National Coalition for Dialogue & Deliberation. Fostering a world of conversation, participation, and action. Retrieved October 10 2008 from

Speight, S. L. & Vera, E. M. (2004). A social justice agenda: Ready or not? The Counseling Psychologist, 32, 109-118.

United Nations (2000) Millennium Development Goals. Retrieved August 12 2008 from

Vera, E. M. & Speight, S. L. (2003). Multicultural competence, social justice, and counseling psychology: Expanding our roles. The Counseling Psychologist, 31, 253-272.

Young, I. M. (1990). Justice and the politics of difference. Princeton, NJ: Princeton University Press.

Young, I. M. (2000). Inclusion and democracy. Oxford: Oxford University Press.

Warnke, G. (1997). Justice and interpretation. Cambridge, MA: MIT Press.

Wednesday, February 25, 2009

Threats to Child Development in Developing Countries

In 2007, The Lancet published a significant and influential series, Child Development in Developing Countries, which reviews research demonstrating (a) the failure in developing countries of over 200 million children under 5 years of age to achieve their developmental prospects, (b) the biological and psychosocial risks faced by these children living in extreme poverty, and (c) effective interventions which are as yet underutilized in countries where they are needed most.

The failures of children to reach their developmental potential in developing countries can be attributed to poverty and its correlates—poor health and nutrition and inadequate care results in “poor levels of cognition and education, both of which are linked to later earnings” (Grantham-McGregor, et al., 2007, p. 60). Grantham-McGregor, et al (2007) estimate that the percentage of children who are living in poverty and physically stunted in Sub-Saharan Africa, South Asia, and developing countries are 61%, 52% and 39%, respectively. These children will achieve fewer years of schooling and learn less per year than children in wealthy parts of the world, resulting in an estimated 19.8% deficit in adult yearly income. Poverty begets poverty, and this intergenerational transmission of poverty results growing numbers of citizens unable to become active contributors to improving their nation’s fragile development goals in the face of globalization. Most nations who are members of the United Nations have ratified the articles in the 1998 Convention on the Rights of the Child (Article 6: Survival and development) and their development goals are reflected in the 2000 UN Millennium Declaration; six of the latter’s eight goals are relevant to child development and meeting the articles of the UN’s Rights of the Child.

1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases

Both the World Health Organization (WHO) and UNICEF have since the UN Millennium Declaration made substantial financial contributions to support child development programs in developing countries, and progress has been made in the Education for All (EFA) Millennium Goal (EFA Global Monitoring Report, 2007). Yet the focus on young children’s early development has only recently come to the attention of global service organizations, to some degree incited by the 2007 Lancet series, and further verified by the 5th edition of the EFA Global Monitoring Report (2007).

“Poverty is not a distinct episode or state; rather, it is a conglomerate of conditions and events that create pervasive hardship and stress” and affects children through multiple mechanisms (Richter, 2003, p. 244). Poverty increases risk factors in children and their parents and support systems; protective factors for all three are less present than in the more affluent. According to South African research, Linda Richter, “risk factors accumulate and concentrate over time, and few opportunities are available for children in poverty to escape from these cumulative effects or to benefit from interventions that might ameliorate their impact” (Richter, 2003, p. 224).
Risk factors for poor child development under conditions of poverty identified in the few existing research publications can be distributed into two categories: biological and psychosocial risks (Walker, Wachs, Lozoff, Wasserman, et al., 2007). Excluding genetic factors, the biological risks are poor nutrition (low birth weight and stunting), iodine and iron deficiencies, vulnerabilities to infectious diseases, and environmental exposures (lead, arsenic, and pesticides in-utero) (Walker, et al., 2007). Psychosocial risks can be clustered into inadequate parenting factors and exposure to violence; studies have found the former to be consistently related to children’s cognitive and social-emotional competencies (Walker, 2007). The most reliable parenting characteristics associated with positive early developmental outcomes are cognitive stimulation and child learning opportunities, caregivers’ sensitivity and responsivity to the child, and maternal mood (depression) (Walker, 2007).

Tragically, many children growing up in developing countries are exposed to considerable levels of violence, whether in their homes or in their communities, and the likelihood of being exposed to violence is increased when there are disruptions in family cohesion or the mental health of primary caregivers (Walker, 2007). Most of the poorest nations are undergoing violent political unrest, civil wars, and violently oppressive governments, so the odds of children feeling unsafe in their communities or becoming victims of traumatic events are high. Further, the HIV/AIDS pandemic (more later) is decimating the working age adults in sub-Saharan Africa and south Asia, resulting in child-headed households that expose children to greater risk of becoming objects of violence or exploitation in order to survive. Another common outcome for children orphaned by AIDS is to live in grandmother-headed households; their grannies are typically beyond their wage-earning capabilities, which magnifies the degree of poverty experienced by family, leading to the inability to pay school fees, school drop-outs, delinquency, unemployment, etc.

The conditions of impoverished communities foment violence among members, whether due to the effects of drug and alcohol abuse on parents’ self-regulation skills and poor judgment in the care of their children, or due to the violence caused by delinquent youth, civil wars, and systematic government oppression. It is no stretch of the mind to come up with a list of international communities where violence has been the norm for long periods of time: Los Angeles, El Salvador, Guatemala, Columbia, Haiti, Afghanistan, Iraq, Palestine, Lebanon, Israel, Northern Ireland, Somalia, Rwanda, the Democratic Republic of Congo, Zimbabwe, Black South African townships, to name a few. Research on the effects of exposure to violence on children asks us to make a distinction between acute danger and chronic danger (Garbarino, 1993). Children’s recovery from acute danger requires a change in their conditions of life and new ways of understanding of life events; chronic danger, on the other hand, requires developmental adjustments that are likely to include “developmental impairment, physical damage, and emotional trauma, and will be socialized into a model of fear, violence, and hatred…” (Garbarino, 1993, p. 107). While the psychological availability and reassurance of parents and caregivers can improve children’s long-term prognosis after events of acute violnece, chronic violence in the community negatively impacts parents, whose own psychological resources are destabilized or destroyed (Garabino, 1993). For example, in Rwanda where there is a very high number of adolescent-headed households due to both AIDS and the genocide of 1994, the high levels of emotional suffering in young children are related to “high levels of depressive symptoms and social isolation” experienced by their heads of household (Boris, Thurman, Snider, Spencer, & Brown, 2006).

While there are yet few quality studies on the effectiveness of ECD interventions in the developing world, there are promising results in existing international examples. The most common interventions originate from health care and educational programs that monitor the growth and improve hygiene and health services, or offer child care in centers outside the home (Engle, et al., 2007). ECD programs are center-based, home-base, including parent training and parent-child support, and comprehensive (center & home-based care). According to Engle, et al. in the 3rd Lancet article (2007),

The most effective interventions are comprehensive programmes for younger and disadvantaged children and families that are of adequate duration, intensity, quality, and are integrated with health and nutrition services. Providing services directly to the children and including an active parenting and skill-building component is a more effective strategy than providing information alone. p. 239

The 2007 Lancet series on early child development in developing countries is a call to governments, NGOs and civil society is to step up the proliferation of effective and efficient early child development programs, bringing them to up to match the enormous scale of the problem (Engle, Black, Behrman, Cabral de Mello, Gertler, Kapiriri, Young, & the International Child Development Steering Group, 2007).

There is something a little too reassuring about the Lancet’s reports on research on early childhood development risks and interventions, with its emphasis on bringing specific, empirically researchable programs to scale in developing (aka, impoverished) countries. This illusion of confidence is based on the absence of any critique of the economic and political systems that create and perpetuate poverty and oppression. Omitted is any reference to the role of globalization, as global capitalism, in creating and maintaining economic hardship in some parts of the world. I will not tackle that here, except to say that the policies of the International Monetary Fund (IMF) and World Bank (WB) have led to the eroded the health care systems and increases in poverty in Africa (Hunter, 2003); the resulting lack of basic resources (food, clothing, water, sanitation, shelter, employment, access to health care, and lack of education) was fodder to the mushrooming AIDS pandemic.

The Lancet’s other omission is having given bare attention to the complex, gnarly and devastating repercussions from the mushrooming HIV/AIDS pandemic on the poorest regions of the globe. With the spread of the virus, most pre-existing family and community systems of the poor in developing countries have fallen apart, not only further diminishing the capabilities of parents to care for their young children, but removing parents from the equation altogether. AIDS is overwhelming children’s already overburdened communities as well as decimating the rolls of current and potential service providers, both professional and non-professional. For example, when Botswana finally was able to distribute antiretroviral treatments to its devastated citizens, there were no longer enough living adults in health care to administer the treatments.