by Gary W. Evans, Theodor D. Wachs, Washington, DC, American Psychological Association, 2010, 277 pp, Hard Cover, $59.95
As someone who spends his days dealing with whole children, one at a time, I found the experience of reading 260 pages devoted to the scholarly dissection of a concept at once invigorating and frustrating. In sharp contrast to its topic, and to the often dizzying experience of seeing actual patients, the book strives to impose order. The volume is organized in neat accordance with Urie Bronfenbrenner's bioecological model, with its deceptively simple hierarchy of microsystem, mesosystem, exosystem, and macrosystem. Each of these layers comprises a section heading for several chapters, each coming from a different angle, like the proverbial blind men palpating the elephant. Another helpful heuristic is the application by most of the authors of Bronfenbrenner's model of person, process, context, and time.
It is not easy to rein in chaos, however, either the thing or the concept. A definition of chaos endorsed by several of the authors includes exposure to environmental noise (e.g., airplanes landing and taking off), crowding (typically measured in people per room), and instability and unpredictable change. These factors may boil down to 2 constituents, disorder and turbulence. Yet, in other places, the authors describe chaos as “a sense of too much happening at once” or “feeling hectic or that one's life is out of control.” Chaos may affect children not only by impairing their learning or limiting their opportunities to acquire social skills but also by creating disorder in the child's internal emotional landscape because of disorganization and dysregulation in the world outside.
Much space is devoted to establishing the relationship—overlapping but distinct—between chaos and poverty. In a simple model, poverty gives rise to chaos, which in turn impairs parenting and other relationships upon which development depends. In a more nuanced view, best articulated by Arnold Sameroff in the concluding chapter, chaos mediates some of the effects of poverty and moderates and is moderated by still others. Those motivated by a search for simplicity may want to pick up a different book.
Academic child psychologists are sure to find much in Chaos to stimulate their thinking. The 25 authors are (if I am judging correctly) tops in their fields and well positioned to sketch the cutting edge. The writing throughout the volume is mostly clear, if only focally graceful. The chapters cover a breadth of research, although depth and data are often wanting, leaving the reader to wonder whether statistically significant findings are also clinically meaningful.
That said, there are plenty of fascinating parts, including the discussion of how chaos in the United States has declined overall while becoming increasingly concentrated among minority and low-income families; the observation that excessive noise and crowding are both associated with deficits in reading ability; the idea that disorganization may best be measured as a neighborhood-level variable; and many illustrations of how chaos in one setting (say, the workplace or childcare) flows over into the home and how the reverse also occurs. (The idea that microsystem factors, in particular harsh parenting, also flow uphill to affect national values and policy is one I find compelling, although I did not find it in this book; I think credit goes to Benjamin Spock for that insight.)
Bringing the theoretical home, Chaos led me to reflect on the chaos that is, too often, a feature of life in an urban, academic medical center: the waiting room filled to overflowing; the sign-out area on a busy afternoon; and the chaotic work schedules experienced by our residents. Back in the examination room, talking with a teenager who has been fighting in school or running the streets, it is easy to perceive the handball of chaos ricocheting up and down Bronfenbrenner's ecological levels. By shining a light on chaos, the chapters in this volume make the more pressing question—What to do about it—stand out even more starkly.
Robert Needlman, MD
General Academic Pediatrics
MetroHealth Medical Center
Case Western Reserve University School of Medicine