BOOK REVIEWS Affect Dysregulation and Disorders of the Self. By Alan N. Schore, Ph.D. New York: W.W. Norton, 2003, 403 pp., $45.00 (hardcover) Affect Regulation and the Repair of the Self. By Alan N. Schore, Ph.D. New York: W.W. Norton, 2003, 363 pp., $45.00 (hardcover) It was at the 11th International Congress of the Associa- tion for Prenatal and Perinatal Psychology and Health (APPPAH), entitled ‘‘Birth, Brain, and Bonding: The Psy- chology and Science of Attachment,’’ that I was first intro- duced to Dr. Schore’s work. An APPPAH meeting in San Francisco is a rich mix of viewpoints and experience, a bazaar of birth enthusiasts ranging from neonatologists, obstetri- cians, midwives, and doulas to body-workers, massage thera- pists, and rebirthers. Several speakers, among them John Bowlby’s son, Sir Richard Bowlby, referred to Schore’s con- ceptualization of ‘‘experience-dependent’’ development of the infant’s brain in the context of a relationship with its pri- mary caregiver, usually its mother. The idea that one’s genes are not one’s destiny—indeed that gene expression leading to the formation of specific neural circuits requires specific care- giver–infant interactions–struck me as exciting. Bowlby, himself not a clinician but a journalist/filmmaker with an enduring regard for his father’s work, had produced a documentary in which various aspects of attachment theory were reviewed. He spoke of the challenge that he felt when interviewing Schore, a reference to the latter’s erudi- tion and tendency to speak in complex theoretical language. Several weeks later, I pounced on the two volumes waiting to be reviewed for the Journal on my mentor’s desk and of- fered to try my hand. What better opportunity for a trainee in child and adolescent psychiatry to delve further into attach- ment theory? Even more so for one who had been a practicing family physician throughout the ‘‘decade of the brain,’’ yet had little to show in the way of sophisticated knowledge of neuroscience. These works are published by Norton as part of a ‘‘Series on Interpersonal Neurobiology’’ intended to be multidisci- plinary in focus and ‘‘to offer mental health professionals a re- view and synthesis of scientific findings often inaccessible to clinicians’’ (frontispiece). The author refers to them as part of a ‘‘triad,’’ linking them with an earlier work, Affect Regulation and the Origin of the Self (1994), which, to this writer’s regret, was not available in the university library. Familiarity with the earlier work is by no means a prerequisite, as one finds ample reference to its central thesis in these pages. So with a compelling subject, cutting-edge research, and an experienced clinician/interpreter having done the heavy lift- ing for the reader, why did it seem like an eternity to get past the first 15 pages? At one point, this reviewer actually wrote out passages by hand on a dry-erase board, hoping thereby to better decipher their meaning. While describing what takes place between a mother and her baby, the author states Dyadically resonating, mirroring gaze transactions thus induce a psy- chobiologically attuned, affect-generating merger state in which a match occurs between the expression of accelerating, rewarding, positively he- donic internal states in both partners (p. 8). A few pages later, the essence of play is captured in these words: Affect-transmitting, attention-focusing social referencing experien- ces are mediated by a fast-acting, dyadic visuoaffective psychobiolog- ical mechanism, and this inter-active dynamic that generates and maintains high levels of the positive affects of elation and excitement allows for the appearance of an ontogenetic adaptation, play behavior (p. 13). And so on. Soldiering ahead does pay off, however, as the author shares fascinating insights into the attachment relationship and the specific neural substrates that both subserve and are shaped by it. Take, for example, the observation, culled from Manning’s work, that ‘‘most human females cradle their infants on the left side of the body (controlled by the right hemisphere).this left-cradling tendency facilitates the flow of affective information from the infant via the left ear and eye to the center for emotional decoding, that is, the right hemisphere of the mother’’ (p. 81). Much theoretical and sci- entific support, including recent neuroimaging studies, is marshaled to make Schore’s case for the earlier maturing right hemisphere, specifically the right orbitofrontal cortex, as the site where a mother ‘‘downloads programs’’ through attach- ment experiences that encode the coping strategies of affect regulation. The role of the orbitofrontal cortex as ‘‘the senior executive of the emotional brain’’ (p. 166) is clearly and con- vincingly described. An exhaustive reference list (70+ pages per volume) is presented so that readers may ‘‘evaluate for themselves the meaning of the current findings of the devel- opmental sciences for both the individual and for the culture’’ (p. xvii). One soon realizes when reading these volumes that instead of a series of chapters cohering in an organic whole, Norton has instead cobbled together a collection of the author’s J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 44:3, MARCH 2005 301