Wednesday, April 29, 2009

Issues in Reporting on Mental Illness

I just got off the phone with Sue, a fellow journalist who is interested in what other journalists need to know about reporting on mental health. Surprisingly, considering that this is what I do full-time, I had never given the matter much thought. I kind of hemmed and hawed. Then I recalled an example of execrable reporting by the NY Times and Boston Globe, and suddenly I was babbling a mile a minute:

Two years ago, the NY Times and Boston Globe broke the story of the tragic death of Rebecca Riley, age 4, who died from a drug overdose after being diagnosed with bipolar disorder. Rebecca's parents are awaiting criminal trial, and civil action has been taken against the prescribing physician.

In the initial stories and follow-ups, it became apparent that if the journalists involved had actually interviewed the parents of kids with bipolar, they certainly hadn't listened. The first duty of a journalist is to listen. This is what we have been trained to do, and virtually all of us excel at it.

In fact, we do a much better job of listening than psychiatrists (who tend to have major issues concerning their self-importance).

For a model example of listening, check out the film, "The Soloist," now in theaters. In one memorable scene, Robert Downey Jr as real-life LA Times columnist Steve Lopez encounters a strange man on the streets playing a violin with two strings. Intrigued, Lopez initiates a conversation.

The strange man, played by Jamie Foxx, appears to be rambling incoherently. Most of us would walk away at this point. But by encouraging the strange man to keep talking, Lopez is able to lock into coherent fragments of this man's side of the conversation. He learns that the man's name is Nathaniel Ayers, that the streets of LA is what he calls home, and that he had attended Julliard.

The idea of a Julliard education stands in complete contradiction to the appearance and behavior of this strange man, and no one would have blamed Lopez had he chosen to end the conversation then and there. But Lopez took the trouble to investigate the man's seemingly delusional assertion. Bingo!

Back to the NY Times and Boston Globe: The idea that young kids may have severe mental illness runs counter to our beliefs. It is easier, instead, to believe that innocent kids are suffering in the hands of bad parents and overzealous doctors. That's the story the media ran with. It wasn't that the reporters were pandering to the public's prejudice and ignorance; they were merely writing their stories according to the dictates of their own.

Had the journalists actually listened to the parents, their realities would have shifted. They would have reported the facts of Rebecca Riley's death in a way that acknowledged the tragedy of innocents being robbed of their childhoods and the terrible burden this places on their families.

Instead, the Times and the Globe chose to frame early-onset bipolar in terms of a "controversy," as if the diagnosis does not have wide acceptance by expert clinicians and as if psychiatry were medicalizing types of behavior that others would call normal.

This is absolutely not the case. Expert agreement on early-onset bipolar is by no means unanimous, but most of the debate stems from boundary disputes between the ADHD specialists and the bipolar specialists. Most of the rest involves academic food fights over where to set diagnostic thresholds.

It is conceivable that the experts may come up with an entirely new diagnosis to describe bipolar-like behavior in young kids, but - listen to the parents - the phenomenon, however one chooses to define it, is horrific and real.

Lesson: Watch for stories that report issues as "controversial."

The true controversy concerns medical intervention, but again the media botched that part of the story. We read - over and over - that these kids are being prescribed "powerful" medications. Reality check: Next time you are being prepped for surgery, ask for a "weak" anesthetic.

The media also mentioned that these meds had not been approved by the FDA for use in kids, a trap journalists tend to fall into when reporting other types of medical stories. What the media forgets is that off-label use of meds often constitutes best medical practice.

The FDA regulates the sale of medicine, not the practice of medicine. The process of approval for any drug is initiated by an application from its manufacturer, which in turn arises from clinical trials based on marketing decisions. Thus, Eli Lilly and others initially sought FDA approval for their SSRIs as antidepressants rather than as anti-anxiety meds (which had a bad reputation at the time).

So, imagine if the drug companies had not - a few years later - sought FDA indications for different types of anxiety for their SSRIs. And suppose you have anxiety, but can't tolerate a benzodiazepine. Is your psychiatrist supposed to give up on you?

The Times and Globe missed this completely. Instead, in their reporting, they raised the innuendo of overzealous doctors recklessly and illegally endangering our kids. What they failed to report was that two major psychiatric treatment guidelines recommend the use of medications for kids with bipolar, including one put out by the American Psychiatric Association, and another published in the Journal of the American Academy of Child and Adolescent Psychiatry.

(We can debate the merits of these recommendations, but that is another discussion entirely.)

I did make it clear in my conversation with Sue that for the most part I am very happy with the way mental illness is reported in the media (leaving out those shock-horror stories involving deranged people on killing sprees). Health journalists work very hard at getting vital information out to a concerned public under extremely difficult conditions, and I am proud to consider myself one of them.

In my experience, when it comes to reporting on mental illness, to a person they "get it." The Rebecca Riley story happened to be one of the unfortunate exceptions.


Krista said...

My other issue is one-sided reporting. I have seen too many stories that over focus on the truly negative factors of mental illness. making people seem like "monsters" or "unfixable" or that the only option is locking them away and taking away their rights. I want to see more respectful portrayals of mental illness in the news or in journalism. They don't need to gloss over the negatives, just not make it seem that those things are all that makes up a person.

John McManamy said...

Hi, Krista. These tend to be the shock-horror stories I referred to, and the media does need to reform itself here. But when they're not reacting to a some spectacular killing spree, they tend to get passing grades. Check out the Newsweek cover story on growing up bipolar a few blogs ago.