The bipolar child: myth or reality?
I've been fairly candid about my opinion of the increase in bipolar diagnosis: It's bunkum. The more something gets into the public consciousness, the more people report it. It's a zeitgeist contagion, and even I'm not immune. Last night, I was talking to a mental health activist at the University of Pennsylvania. She said she always thought Sylvia Plath (pictured) was schizophrenic, but learned at a Mental Health Awareness Week Quizo (brilliant idea, BTW) that Plath was actually depressed. "Well," I said, "today she'd probably be diagnosed as bipolar."
Then I thought about it: Why did I say that? Nothing in Plath's chronicle of her struggle or her history suggests bipolar disorder; I said it because it has become a reflex. It's almost as though people are questioning the very existence of clinical depression. I'd hate for people to think, "Have I ever been in a good mood? I guess I'm bipolar!" And the increase in diagnosis among clinicians has more to do with big pharma than observable patterns of behavior (she said cynically).
In the recent past this flurry of bipolar enthusiasm has garnered media attention, due, in part, to the case of Rebecca Riley, the little girl who was diagnosed with BP at age 2, and who died of an overdose of her psych meds. Her story is horrifying. I am completely opposed to using multiple psych meds in small children, and I'm extremely wary of attributing a 2-year-old's behavior to a complex (and not fully understood) disorder like bipolar. Okay, I'm being cagey in case a p-doc challenges me. The truth is, I simply do not believe it's possible to diagnose a toddler with mental illness.
When I was 9, I started exhibiting bizarre compulsive behaviors, which I won't get into now, but which may arise in a future column. My mother was concerned, and had me talk to a friend of hers who was a psychiatrist, who believed the problem was not with my brain, but with my mind. She linked the behaviors to anxiety, and worked with me to identify the source of the anxiety. The behaviors disappeared.
Many years later, in my 20s, I began to exhibit similar behavior. I was diagnosed with OCD and put on Klonopin, a drug I became addicted to and stayed on until just a couple years ago, when I went through the hell of withdrawal. I cannot imagine how my growth--both physical and mental--would have been compromised had I been put on OCD meds as a 9-year-old. And yet, if the same episode took place today, I would most certainly be given drugs as the first line of defense. I'm so grateful that didn't happen.
There will be a backlash to all this overdiagnosing and overmedicating, and I hope it begins with a serious reassessment of what we're doing to generations of children when we put them on harsh psych drugs as small children. I know of kids who started meds at 5 and have never been off them, even through college. How do these people have any idea what's truly wrong? How is it possible that their family practitioners keep calling the prescription in to the pharmacy without requiring a consultation with a psychiatrist--someone new to the case?
Ugh. I could go on and on, but you should head over to Furious Seasons, where there's some heated debate on this subject. This is an issue that cannot be ignored.
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Comments
"I cannot imagine how my growth--both physical and mental--would have been compromised had I been put on OCD meds as a 9-year-old." At age 11, I started seeing a psychiatrist four times a week who prescribed Thorazine for my OCD. He continued to increase the dosage without associating the photosensitivity I experienced with the medication he prescribed. Eventually, the photosensitivity became so severe that I largely ceased going outside. My inability to engage in normal childhood outdoor activities caused me to dissipate my energy in my family's apartment. This led, in part, to my placement in residential treatment where I spent the next three years.
Posted by: Anonymous | March 30, 2007 12:31 PM
Let me say I really don't know the answer to this one, I can only follow my instincts, experience and my doctor, who I like.
He believes, as I think I do, that classic onset of BP is around 17-20.
Even though I had multiple manic episodes ending in psychosis during those years and a bit beyond, I was so unaware of mental health, I chalked it up to youthful personal nuttiness.
Personally, I'm glad I never took a mental health med until I was 36, was never classified or labled.
However, I will end again, with this is just my experience and I know next to nothing about medicine. I do find it sad kids are medicated. I also find it sad there are a million sex workers under the age of 16 worldwide. I just don't know the answers.
Posted by: Annette | March 30, 2007 01:36 PM
There has been a remarkable increase in the awareness of bipolar disorder recently. This is partly due to pharmaceutical/academic campaigns such as the infamous Lilly campaign much maligned by the likes of David Healy in the UK, but it is also due I think to a genuine desire by psychiatrists and sufferers alike to blow away the stigma and misunderstanding associated with the label of BPD. The recent television documentary on the subject presented by the commedian Stephen Fry, in which he discusses in great detail his own illness, had a great impact on awareness in the UK.
As a researcher into bipolar disorder in the pharmaceutical industry I have listened to many discussions about "early onset" bipolar disorder. I have never heard comments that might justify the charge of disease mongering, but I have myself considered whether there might be a prodromal state of bipolar disorder that might be treated in order to prevent the emergence of the full blown disorder. For example, if a child's family history suggests that he or she is at risk of BPD, then would it be worthwhile considering lifestyle changes or career counseling to avoid the stressors that can precipitate the illness? Easier said than done! However, I do agree that medication would probably not be the best approach... yet. The problem is that we know so little about the aetiology and development of BPD, and given the plasticity of a child's brain we risk alot giving medications that we know can alter brain chemistry and function. We've got a very long way to go with BPD; however, I'm hopefull that we are making some progress. There certainly needs to be more informed debate on the subject of childhood mental illness, because if the adult disorder does arise from changes occuring during adolescence or earlier then there may be a much better chance of applying a correctional treatment at that stage.
Posted by: Charles | March 31, 2007 08:55 AM