Child Abuse and CultureYWorking With DiverseFamilies. By Lisa Aronson Fontes. New York: The GuilfordPress, 2005, 239 pp., $30.00 (hardcover).

Your next-door neighbourIis not a man; he is an environment. He isthe barking of a dog; he is the noise of a pianola; he is a dispute about aparty wall; he is drains that are worse than yours, or roses that are betterthan yours.VG.K. Chesterton, 1920

On receiving an invitation to review a book from a numberof titles sent tome, I chose this volume almost as a reflex. Beinga minority member myself and already interested in cross-cultural aspects, I thought I was getting myself an interestingread and a simple and pleasant task. With each page read,though, I found the book relegating me from a presumablyenlightened position to one of cultural blinders worn as snugglyas did those I had derided as insensitive. It is important tounderstand that I hail from one of those Bother[ cultures andhavemerely lived and trained in theUnited States for the past 6years. Yet I was forced to face the fact that my Bprofessionalculture[ had subtly led me to view any behavior that was notpart of the dominant culture as deviant. As described by Jon R.Conte in the book’s foreword, I realized, quite to my dismay,that I had become BEurocentric.[The face of the United States is slowly evolving to become

more multicolored and multicultured than ever before. Thepopulation is shifting from being primarily white or AfricanAmerican to amyriad of cultures such that no one ethnic groupis in overwhelming majority over the other. This developingcollage of the U.S. map is a compelling invitation for amovement toward cultural competence, especially in the healthcare practices. The health care sector is rightfully responding,but perhaps not speedily enough. At a time when one state(New Jersey) has added cultural competency to its medicallicensure laws and other states are following suit, it is almostimprudent to ignore cultural medicine as a new frontier inhealth care.Child maltreatment can be considered a kaleidoscopic

concept altering in meaning and appearance each time it islooked at from a different cultural eye. The fact that everychild has a right to a violence-free and nonabusive liferemains unquestioned. However, what constitutes childabuse in the Western world has been defined from a narrow,ethnocentric, and culturally imperialistic perspective and haslittle grounding in cultural diversity. It follows thatprofessionals working with maltreated children may also

lack cultural competence in their assessments, evaluations,and treatment recommendations for culturally diversefamilies. This tunnel vision regarding child abuse, onestemming from years of white privilege and possible racism,has potential pitfalls regarding decisions for what is deemedbest for a child who suspected of having been abused.Because the need for cultural competence is being

increasingly recognized by a number of governmental andnongovernmental agencies, this volume makes a timelyappearance. From the outset, it should be noted that thebook is written with authority, sensitivity, and even-handedness. Fontes has her finger on the pulse of thedifferent cultural nuances that define a family, and the bookis peppered with examples and clinical vignettes that arerelevant and illustrative of the point being made. Childmaltreatment is explored with a fine-toothed comb: whatmay or may not constitute abuse in diverse cultures is visitedand a format is provided to make the approach andassessment of families culturally sensitive. Very aptly, theword Bsacred[ is used to describe the professional/clientencounter, the relationship termed Bnoble[ (p. 29). Thisdemonstrates a keen insight into the baring nature ofrevelation that is expected of the child and family and thetrust that should be conveyed by the professionals seekingsuch intimate details.Needless to say, a sensitive and comprehensive approach to

these patients and their respective families would constitute athorough knowledge of where they come from. The bookrepeatedly entreats an incisive reader to shed bias andpresumptions, conscious ones as well as those still unknownto the reader.Without appearing to sound pejorative, it forcesthe readers to examine their own practice for subtle signs ofprejudice, stereotyping, ungrounded assumptions, and attimes overt dislike of different cultural groups. This maybecome evident in hurried interviews, using interpreterspoorly versed in child maltreatment, holding differingstandards of treatment recommendations, and failing todevelop a trusting alliance.The language barrier is another key issue to examine. The

use of interpreters, the decision to let clients speak in Englisheven if it is a second language for them, or the body languagethat is missed or misinterpreted are all potential pitfalls. Mymind kept reverting to the movie Lost in Translation andhow a language transcends mere communication and is aculture of its own. Fontes calls upon professionals to respectlanguage, that Bskin that we speak[ (p. 17), Ban intimate

B O O K R E V I E W S Assistant Editor: Andres Martin, M.D., M.P.H.

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expression of identity[ (p. 17); rejecting language orshowing impatience with it being tantamount to rejectingthe person. Professionals are urged to Blisten[ and do theirBbest to understand[ (p. 16).As legal residents and economically sound members of

society, professionals may at times fail to understand thesubtle nuances and paranoia exhibited by immigrants,families hovering at the edge of poverty, cultures withhistories of discrimination, and ethnic groups lacking Bwhiteprivilege.[ The book not only sensitizes the reader tocultural diversity and its acceptance but also provides aconceptual framework for a culturally competent approachto the assessment and treatment of child maltreatment cases.With case examples and corroborated by research findings,the book urges child welfare agencies and professionals toface up to the challenge of the changing demographics of theUnited States. This may entail big measures like changingthe child abuse philosophy from Bgeneric[ to culturesensitive, and small ones like changing the decor of a childwelfare agency to be welcoming for diverse cultural groups.Gene Roddenberry, the creator of Star Trek, once appro-priately said, BIf man is to survive, he will have learned totake a delight in the essential differences between men andbetween cultures. He will learn that differences in ideas andattitudes are a delight, part of life’s exciting variety, notsomething to fear[ (Roddenberry, 2006).Although the book is written with child welfare profes-

sionals in mind, it is a provocative and thoughtful read foranyone who works closely with culturally diverse populationof children and their families. It is an invitation to take a stephigher to a new level of awareness and a deeper level ofunderstanding of the clients and patients with whom wework, an invitation that is hard to turn down.

DOI: 10.1097/01.chi.0000215535.29531.06

Ayesha I. Mian, M.D.The Menninger Clinic

Department of PsychiatryBaylor College of Medicine

Houston

Disclosure: The author has no financial relationships to disclose.

Chesterton GK (1920/2005), The Irishman. In: The Uses of DiversityVABook of Essays. Whitefish, MT: Kessinger

Roddenberry G. In: Inside Trek: A Star Trek Memoir. http://www.insidetrek.com. Accessed January 31, 2006

From Child Sexual Abuse to Adult Sexual Risk: Trauma,Revictimization, and Intervention. Edited by Linda J.Koenig, Lynda S. Doll, Ann O’Leary, and Willo Pequegnat.Washington, DC: American Psychological Association, 2004,346 pp., $49.95 (hardcover).

This volume illustrates the broad (and growing?) dividebetween basic and applied behavioral scientists. The editorscomprise a group of distinguished behavioral scientistsconcerned with the link between childhood sexual abuseand adult vulnerability to sexually transmitted diseases, chiefof which is HIV. Researchers of many stripesVpublic health,behavioral health, trauma specialistsVwill gain both a longi-tudinal perspective and grasp of the current status of theoryfrom the mass of epidemiological and psychobehavioralresearch they have assembled and collated. The book is densewith research references, an average of 125 references perchapter, and analyses of competing theories. Child sexualabuse (CSA) is revealed as the most significant factor leadingto adult sexual victimization. The connection is mediated,however, by adolescent sexual assault. The editors find thatCSA increases risk of an adolescent assault, which in turnpredicts adult sexual abuse. By itself sexual assault in childhooddoes not directly increase the risk of adult sexual abuse; BFirst,there isaconnection,andsecond, it isnotadirect link[ (p.117).In chapters such as BCSA and Adult Sexual Relationships:Review and Perspective[ and BCSA and Adult SexualRevictimization,[ we are urged to think of the impact of CSAon the course of development as lying along a continuum.Various models of the relationship between childhood

victimization and adult behavior are examined and con-trasted. The authors find that trauma theory fails to accountfor the heterogeneity of outcomes, and attachment theory hasyielded inadequate research and a relative lack of data onnormal child sexual development. A more general model,Bevolutionary theory,[ is proposed as an Battempt to begin toconceptualize the wide range of sexual outcomes associatedwith a CSA history. One can assume that evolution will selectfor effective sexual functioning as an adaptive outcomebecause sexual functioning fosters reproduction and mayeven contribute to stability in the nurturance of theoffspring[ (pp. 17Y18). The authors propose that anevolutionary model holds the best promise of answeringwhy some victims are more resilient than others.The editors try to help clinicians translate these conclu-

sions into useful preventive or therapeutic interventions. Forexample, the authors offer an explanation of dissociativetendencies based on Bbetrayal trauma.[ They begin by notingthat children sexually victimized by caretakers tend to showgreater immediate and long-term memory impairment thanvictims of noncaretakers because Bchild abuse by a caregiver

BOOK REVIEWS

626 J . AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 45:5, MAY 2006

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