When Your Child Is Sick

Book Review

by Joanna Breyer
New York: TarcherPerigee-Penquin Random House, 2018
448 pages • $16.00 (paperback)

When Your Child is Sick is the work of psychologist Joanna Hare Breyer, PhD, she is the wife of Supreme Court Justice Stephen Breyer. Her professional career has followed the less public path of compassion, empathy, and helping children and their families deal with the demon of cancer. Upon her retirement, instead of a memoir, she set out to distill and pass on everything she had learned. Who would have thought it possible to sum up such a career in a handbook that provides guidance to everyone involved with sick children?

Dr Breyer’s writing aims at parents, but her reach touches every person and professional involved in the care of very sick children. Hospitals that treat children with cancer are divided among many subspecialties each with its own teams and technicians so that fragmented care seems inevitable. This is surely bewildering to children and their families when life threatening illness strikes and all that high powered medical science has to offer is brought to bear. Dr Breyer, untrained in medicine, has managed to understand it all and translated it into a language that can be understood. One is reminded as one reads her book of Emerson’s well-known quote, “Common sense is genius dressed in work clothes.”

A diagnosis of cancer in a child breeds helplessness, bewilderment, and desperation. If there is a red thread in this deeply informative book it is the many pragmatic and creative ways Dr Breyer has devised to help children and their families overcome those feelings of helplessness and despair. Dr Breyer has the skills, empathic and professional, to grasp all the parameters of treatment and help the family to understand, to cope, and to participate in the treatment.

She calls herself a psycho-social counselor, but she is more than that. She knows every resource that can support the family and every psychological device that can help the child cope with pain, disfigurement, and even suicidal despair. Working with children in pain who fear the next procedure, she finds ways to give them a sense of mastery.

Each chapter has a case example that explains what she does. In a particularly touching example, she created a game to help a suicidal ten-year-old cope with self-destructive impulses. At a certain point in the game the child smiled at her and said, “I know what you’re doing, but I like it.” What an enviable account of a therapeutic alliance in a desperate situation.

Dr Breyer goes on to describe coping techniques: breathing and relaxation, guided imagery, hypnosis, auto-hypnosis, and many others. There is practical guidance at every turn to ease suffering and promote mastery and resiliency. The book has no theoretical pretense, every chapter describes where the “rubber hits the road.”

This is a book that should be put in the hands of every family bringing a child with cancer to a hospital and every professional involved in the care of these children. But it is also a book for mental health professionals to read, to learn, and to admire a vocation of caring in the presence of death. Dr Breyer has repeatedly faced death with children. What does one answer when a child asks, “Am I going to die?” She offers suggestions for children at different developmental ages and for their parents. It is a book I wish I had read in medical school. Here is wisdom about mortality and the human condition without pretense or posturing. Here is a selfless portrait of a vocation.

Disclosures:

Dr Stone is Touroff-Glueck Professor of Law and Psychiatry, Faculty of Law and the Faculty of Medicine, Emeritus, Harvard University.