Tuesday, June 21, 2011
The first attack is in the form of a June 8 article in the New Scientist by author Jon Ronson. “Bipolar Kids: Victims of the Madness Industry?” it reads, drawn from his new book, The Psychopath Test. “The problem is the apparent epidemic isn’t real,” Ronson asserts.
The next is a June 19 article in Newsweek by Stuart Kaplan MD, who has expert credentials as a child psychiatrist. The article - "Mommy, Am I Really Bipolar?" - is adapted from his new book, Your Child Does Not Have Bipolar Disorder. “There is no scientific evidence to support the belief that bipolar disorder surfaces in childhood,” Kaplan flatly asserts.
Except, perhaps, for a whole bunch of kids who cycle in and out of depression and mania?
Oh, THAT evidence. Well, no, says Kaplan. These kids are really ADHD or oppositionally defiant. Or have something called “temper dysregulation disorder.”
This is much the same argument Ronson makes, the anything-but-bipolar argument. It cannot possibly be bipolar. It has to be something else. “Attention deficit disorder,” he quotes a friendly doctor.
Except when it misses by a country mile. This from Julie from about ten years back, whose six-year-old kid was diagnosed with ADHD:
Doctors will not officially diagnose a child this young with bipolar. ... No one can possibly relate to the problems a mother must endure for a child like this. I ask God several times a day why couldn't I have just had a normal child. Why must I fight to get his medicine right? Why must I miss work to care for him? Why can't we go out to eat without an episode? I also have two girls (ages two and 12 ) that must watch his behavior escalate to the point where he knocks holes in the walls, pees in the closet and tears up his and their favorite toys. I feel so alone and drained. I have nowhere else to turn.
At least these days no one save the antipsychiatry movement is advancing a conspiracy theory having to do with Pharma pathologizing and medicating “normal” kid behavior to boost revenues. Kids who knock holes in walls and pee in closets definitely require some kind of therapeutic intervention. No one is seriously arguing otherwise.
Back in the 1990s, Joseph Biederman of Harvard began publishing articles to the effect that some of the so-called ADHD kids in his clinic were behaving in ways that more closely resembled bipolar. The issue is extremely complex and confusing, as ADHD and bipolar symptoms overlap plus a good many kids would qualify for both diagnoses.
Coincidentally, a good many parents were noticing much the same thing in their own kids. The ADHD meds weren’t working their customary pharmaceutical magic. Antidepressants were making them even worse. Based on the reports of these parents, Janice and Demitri Papolos did their own investigations and published “The Bipolar Child.”
Ronson and Kaplan respond with saddles blazing, replete with the oft-cited tragic death of four-year-old Rebecca Riley (Ronson cites 60 Minutes’ shameless spin as if it were authority). The two authors predictably attack Biederman (and Kaplan the Papoloses) for failing to accomplish Mission Impossible, namely in coming up with a fool-proof universally acceptable and objective diagnostic standard. Earth to Ronson and Kaplan: Diagnostic psychiatry is all sloppy and controversial and subjective.
To bolster his case, Ronson takes the bizarre step of interviewing the two most subjective diagnosticians of all time - Robert Spitzer and Allen Frances, who headed up the DSMs III and IV, respectively. Anyone who is vaguely familiar with Dr Spitzer is aware of his pathological resistance to even the slightest changes to what he regards as his baby. Dr Frances, on the other hand, has come across in recent writings and interviews as a sinner in search of some kind of war crimes tribunal to plead guilty to.
Really, there needs to be a DSM diagnosis for people who head up DSMs.
Dr Kaplan at least grounds his criticisms in his own clinical experience, or so he claims. But, then again, is Dr Beiderman’s own clinical experience no less valid? Isn’t the real point that when it comes to kids in distress, there are no easy answers? That our diagnostic and assessment tools are very blunt instruments at best?
If only bipolar meds did for bipolar kids what ADHD meds do for ADHD kids, we wouldn’t be having this argument. Alas, with bipolar - in kids and adults - there is no quick chemical fix. A kid diagnosed with bipolar is not going to simply get better with bipolar treatment. Quite the opposite, bipolar meds are likely to make the kid worse. We all like easy answers. The easy answer is to flatly deny that bipolar in kids even exists. That it has to be something else: ADHD, conduct disorder, even a new DSM-5 diagnosis concocted totally out of thin air - “temper dysregulation disorder with dysphoria.”
Anything but bipolar. It would certainly be a much happier world if that were the reality. Alas! Reality ...
Further reading from McManweb:
Child Bipolar I
Child Bipolar II
Child Bipolar III
The DSM-5 - Grading Child Bipolar
Are We Over-Medicating Our Kids?
Spitzer and the DSM