Last week I did a few days of editing at Newsweek, where I had the opportunity to work on this fascinating piece by Dr. Stuart Kaplan, who writes that the explosion in bipolar disorder diagnoses for American children and adolescents is a severe medical overreach with potentially deadly consequences. Pediatric bipolar disorder, Kaplan argues, does not exist, and is likely just a combination of ADHD and ODD (Oppositional Defiance Disorder, or anger).
A similar argument is made in a series of articles in the New York Review of Books by Marcia Angell, the Harvard Medical School professor and former editor of the New England Journal of Medicine. Angell believes the pediatric bipolar diagnosis has become commomplace in large part due to the advocacy of pharmaceutical companies, which have lined the pockets of leading psychiatrists. The doctors, Angell suggests, are only too happy to bolster psychiatry's status by embracing drug therapy instead of talk therapy, which, after all, any old social worker or psychologist can provide.
Indeed, it is startling to learn that some psychiatrists now believe that between 1 and 4 percent of all kids suffer from bipolarity, also known as manic-depression–especially because, prior to 1995, the number of children diagnosed with bipolar disorder was close to zero. It is terrifying to read about the drug cocktails doctors routinely prescribe to such children, which include powerful anti-psychotic medications developed for adults, such as lithium, Rispardel, and Abilify, as well as anti-seizure and high-blood pressure drugs, such as Depakote and clonidine, that also have mood-stabilizing effects.
Many of the medicines have serious side effects, including obesity and diabetes. And many children diagnosed with pediatric bipolar disorder never try tamer drugs, such as Ritalin, because proponents of the diagnosis believe such stimulant medications could exacerbate these children's manic episodes.
As persuasive as these pieces of journalism are, however, I think it's important to put them into dialogue with the often-desperate stories of the families whose kids are given such diagnoses. The must-read article is Jennifer Egan's 2008 Times Magazine cover story on pediatric bipolar disorder. Egan met a boy who routinely beat and terrorized his younger sister; a girl who exhibited sexual interest in strange men as a mere toddler, and who beat her brother until welts formed; and a boy who told his mother he would commit suicide if she didn't buy him a lottery ticket–and then ran into oncoming traffic. One mother, who eventually sent her bipolar son to a residential school in order to protect her younger daughter, told Egan, heartbreakingly:
“I used to cry five times a day, and now maybe I only cry once or twice. … So it’s better, you know? It’s better now that I don’t pick him up at school, and he doesn’t rage at me in front of all the other parents. He can rage when he bursts in the door, so no one sees how awful it is. It’s like a dirty little secret. It’s like having a husband who beats you, only it’s a kid. It’s your own."
It's no wonder the mother felt shame. As common as it has become to drop into a weekly therapy session, especially during times of personal crisis, there remains a powerful bias in American culture against mental illness and against aggressive drug-therapy for painful conditions seen as primarily emotional, hormonal or social in origin. As a lifelong migraine sufferer, I've been on the receiving end of many well-intentioned pieces of advice from friends, who wonder if sleeping more, drinking more water, or trying therapeutic massage might cure my several-times-per-week migraines. (I've even been told to "relax.")
Since (obviously) I don't want to be in pain, I've experimented with a number of treatments over the years, from seizure medications and anti-depressants to biofeedback and restricting my alcohol intake. But I can report with utter confidence that the only thing that has ever consistently worked for me, at least thus far, is the strong stuff: the sumatriptan drugs, such as Treximet, that are specially formulated to treat acute migraine pain, but can cause significant side effects, including rebound headaches that sometimes spiral me into days or even weeks of near-constant pain.
I'm not satisfied with that risk, so in a few weeks, I'm going to try one of the newest FDA-approved migraine treatments: Botox injections. Despite stereotypes to the contrary, my migraines don't make me feel special; I don't use them as an excuse to get out of social engagements or leave work early. I hate them. Migraines limit my productivity and happiness, and I'd do pretty much anything reasonably safe to beat them back.
The skepticism about faddish diagnoses like pediatric bipolarity is more than warranted. Medical history is littered with bunk "diseases," like hysteria, and diagnoses that are hotly controversial, such as Morgellons. But skepticism should be accompanied, I think, by a real sense of compassion for the parents and children who are suffering and seeking a name and treatment for their affliction. One of my favorite journalists, Judith Warner, set out in 2005 to write a book about the over-medication of American children. By 2010, when Warner's We've Got Issues was published, she had completely changed her mind about the topic. After hearing stories like the ones in Egan's article, and talking to countless parents and psychiatrists, Warner became convinced that thousands of families' lives are greatly improved each year by the prescription of mood-stabilizing drugs for children.
Their stories need to be told, just as we need to hear about Rebecca Riley, who died at the age of four after her father gave her an overdose of clonidine, a adult blood-pressure medication that had been prescribed to treat bipolarity.