Transcultural Education for Clinical Psychologists, Part #3

Postcolonial Theories

“I think postcolonial scholarship provides a theoretical and historical focus to multiculturalism that makes it attractive to scholars who want to escape the narcissism of mere identity scholarship” Spivak in Hegda & Shome, 2002, p. 271.

“The theoretical base of postcolonial studies also allows for multiplicity to be thought of in a way that is different from just simply the Rainbow Coalition. Within the context of globalization, to be postcolonial seems more appropriate than to be merely metropolitan multicultural. It is a way of dealing with globalization which is after all a fairly recent phenomenon. In order to give globalization historical depth you must move it to postcoloniality” Spivak in Hegda & Shome, 2002, p. 271-272.

Gayatri Chakravorty Spivak’s quotes speak to two of the reasons underlying my proposal for incorporating Postcolonial Theory in a social justice curriculum: (a) the limits of liberal identity politics, and (b) the need to attend to cultural oppression everywhere, particularly now when the politics and economics of globalization are impacting everyone. There are two other reasons, (c) learning from the oppressed, and (d) attending to the psychology of oppression, voiced by Homi Bhabha:

1. "it is from those who have suffered the sentence of history—subjugation, domination, diaspora, displacement—that we learn our most enduring lessons for living and thinking" (p. 172).
   
2. "the affective experience of social marginality—as it emerges in non-canonical cultural forms—transforms our critical strategies. It forces us to . . .engage with culture as an uneven, incomplete production of meaning and value, often composed of incommensurable demands and practices, produced in the act of social survival" (p. 172).

While there is no single uniting definition of what is meant by Postcolonial studies, Homi Bhabha’s elegant introduction captures those elements most relevant to my purpose in this paper:

"Postcolonial criticism bears witness to the unequal and uneven forces of cultural representation involved in the contest for political and social authority within the modern world. Postcolonial perspectives emerge from the colonial testimony of Third World countries and the discourses of ‘minorities’ within the geopolitical divisions of East and West, North and South. . .[their aim is to] intervene in those ideological discourses of modernity that attempt to give a hegemonic ‘normality’ to the uneven development and the differential, often disadvantaged, histories of nations, races, communities, peoples. They formulate their critical revisions around issues of cultural difference, social authority, and political discrimination in order to reveal the antagonistic and ambivalent moments within the ‘rationalizations’ of modernity . . .The postcolonial project, at the most general theoretical level, seeks to explore those social pathologies ‘loss of meaning, conditions of anomie’--that no longer simply ‘luster around class antagonism, [but] break up into widely scattered historical contingencies."

The controversial writings of Fanon, Said, Spivak and Bhabha have decentered European intellectual hegemony in Europe through their criticism of white, patriarchal eurocentrism (Young, 2001). Said extended Foucault’s critique of western epistemic disciplinary power exercised by academic institutions to Orientalism, arguing that European studies of the Middle East had the effect of securing and maintaining western hegemony over the Arabs and Islam (Sharpe, 2005). Gayatri Chakravorty Spivak has revealed imperialism’s “epistemic violence” perpetrated upon colonized women.

Homi Bhabha carried on Said’s poststructural critique incorporating the ‘psychopolitics’ of Antillean Franz Fanon, whose writings demonstrate the unprecedented challenge to understanding unleashed by colonial racism and violence, and convinced one “that the colonial moment of epistemic, cultural, psychical and physical violence makes for a unique kind of historical trauma” (Hook, 2005). Bhabha observed the failure of ideological and discursive approaches “to account for the persistence of racism, its pronounced irrationality, its compulsive qualities, the visceral quality of its hatred, its continuous, seemingly repetitive nature” (Hook, p. 487). Derek Hook suggests that Fanon’s and Bhabha’s application of a psychoanalytic lens to understanding “the vicissitudes of colonial power and its resistances” reflects the hope that these analyses would result in opportunities to intervene “within the life of power” (Hook, 2005, p. 481).

There is a reserved hope that destabilizing the Western canon through resistance could lead to new ways of being that no longer are dependent upon, through accommodation or opposition, imperialist hegemony. For example, Robert Young considers the emergence of postcolonial studies to be “an historical moment of new tricontinental forms of critical analysis and practice” (2001, p.XX) that could lead to the end of western hegemony.

Lyn Carter in Australia, one of the few educators I have found to apply postcolonial theory to diversity issues in teaching (Carter, 2004; 2005), attributes postcolonial theory the means to:

"construct more complex conceptualizations of cultural difference as hybridized and fluid, always in the making, and recast culturally diverse students’ homogenized identities into multiple, mobile, and provisional constructions, more accurately attune to conditions of living and learning under the indeterminacy of the transforming global world” (Carter, 2004, p. 833).

Carter (2005) appreciates in postcolonial criticism what she perceives to exceed western epistemologies, and the practice of double consciousness as “thinking about how thinking intersects with the disciplinary categories themselves” (p. 917).

The postcolonial attitude implicitly calls for immersing oneself in the world of the other. The critical imperative of postcolonial critique, which is addressed by those of the tricontinents to us in the West, is to suspend one’s hegemonic assumptions and disciplinary methodologies and, in true dialogic presence, open oneself to the other from a position of not-knowing. For example, Obioma Nnaemeka asserts that,

"imperialists and colonists never learn from the colonized: they teach them. They do not ask questions; they manufacture answers in search of questions. Border crossing has its dangers, its seduction, its unpredictability, its humbling moments, but it also has its enriching rewards. Border crossing entails learning about the ‘other,’ but more importantly, it should entail learning from the other. Learning about is a gesture that is often tinged with arrogance and an air of superiority; learning from requires a high dose of humility tinged with civility. Learning about often produces arrogant interrogators; learning from requires humble listeners" (2003, p. 374).

From her experiences as an African feminist, Nnaemeka argues for a postcolonial critique that critique lead to the “clearing” of a dialogic third space between borders, where theory and practice, planning and action coexist. She explains:

"Theorizing in a cross-cultural context is fraught with intellectual, political, and ethical questions: the question of provenance (where is the theory coming from?); the question of subjectivity (who authorizes?); the question of positionality (which specific locations and standing [social, political, and intellectual] does it legitimize?). The imperial nature of theory formation must be interrogated to allow for a democratic process that will create room for the intervention, legitimization, and validation of theories formulated ‘elsewhere.’ In other words, theory making should not permanently be a unidirectional enterprise---always emanating from a specific location and applicable to every location---in effect allowing a localized construct to impose a universal validity and application. I argue instead for the possibilities, desirability, and pertinence of a space clearing that allows a multiplicity of different but related frameworks from different locations to touch, intersect, and feed off each other in a way that accommodates different realities and histories" (Nnaemeka, 2003, pp. 362-363).

Nnaemeka’s words point me to the importance of service learning requirements for multicultural education for social justice and a better world. Humbleness and service, combined with openness and not-knowing are the ontological components of a professional’s integration of a heartfelt engagement in social justice work.

Conclusion

I have tried in this essay to articulate a vision of a multicultural education that fosters the commitment to social justice, nourishes the interest in theory, challenges the comfort zones of unconscious hegemony, insists upon informed action, and embodies dialogic reflexivity. I welcome your comments and suggestions.

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.

The 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.

The 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.

Melancholy

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).

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.