Letters from Maine

Far from the tree


Despite having grown up in a home in which every room but one bathroom and the kitchen had at least one wall lined with books, I have never been much of a reader. In light of my relative unfamiliarity with books, I have been hesitant to include reading recommendations in this column. However, I have just finished a month and a half trek through the 700 pages (960 if one includes the notes and index) of a book that should be on every pediatrician’s bedside table.

Intrigued by a few reviews I had seen, I requested "Far from the Tree: Parents, Children and the Search for Identity" as a Christmas gift. Andrew Solomon, the author, has a master’s degree in psychology and is working on his Ph.D. He has written numerous magazine articles and several other books, including "The Noonday Demon: An Atlas of Depression," a popular treatise on depression that won the 2001 National Book Award for nonfiction.

"Far from the Tree" is an extensively researched exploration of parenting in families in which a child was born who shares very little of his or her parents’ identities. While most of the time the apple doesn’t fall far from the tree, every now and then an exceptional child is born. The examples Mr. Solomon has chosen are deafness, dwarfism, Down syndrome, autism, schizophrenia, multiple severe disabilities, children who are prodigies, children of rape, children who become criminals, and who are transgender.

During interviews with more than 300 families, often during several visits spaced over a number of years, he amassed more than 40,000 pages of notes. Each condition is covered in its own chapter, some more than 100 pages in length. Interspersed between individual scenarios, Mr. Solomon includes the history of the condition and a brief update on current therapies and management strategies. Each category presents its own suite of ethical and moral dilemmas, from cochlear implants to abortion based on prenatal testing.

During my career I have encountered numerous children with many of the conditions Mr. Solomon addresses; some of those professional relationships can be measured in decades. Typically the experiences are a collection of scores of 20 or 30 minutes of office or hospital encounters. Constrained by the reality of also being the pediatrician for several thousand other less exceptional children, I never felt I had the time to ask parents how they felt about parenting a child who clearly was in a different universe from what they had expected.

Of course, I often ask parents how they are doing. And, I think I usually have a general sense of how they are coping. I view it as my job to at least attempt to help them find solutions when crises arise. However, I have never taken the time to involve myself in the kind of extended and in-depth interviews Mr. Solomon has done.

Like me, you may have wondered how some families can endure the challenges that a child with multiple severe disabilities presents day after day, year after year, and still appear to have a positive worldview. In "Far from the Tree," you will get at least a glimpse of how that counterintuitive phenomenon can occur. But for many families. an exceptional child is more than they can manage, and Mr. Solomon does not shy away from illuminating this dark side of parenting.

Although well written, this was not an easy book for me to read because of the intensity of the issues it addresses. I had to set it aside for a day or so to digest what I had read, and then return for more. You may or may not find interesting the author’s own journey as a gay man and eventually a parent. However, the meat of the book offers the reader a perspective on parenting of exceptional children that also translates to parenting the child who has fallen closer to tree. I only wish it had been written in 1970 when I was embarking on my career.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@elsevier.com.

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