Another book refuting childhood bipolar DX

There is a groundswell of books appearing on the market that refute the basis of the bipolar diagnosis in childhood. Here’s an interview in the Huffington Post with Stuart Kaplan, MD, author of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Disorder.

There is, indeed, a psychiatric diagnosis called childhood bipolar disorder that used to be reserved for the rare child, but that diagnosis has gotten way out of hand in the past two decades, leading to medicating this “disorder” in growing numbers of children under eighteen. Now, everybody’s child is that “rare” child. I can hear parents complaining, sure, it’s easy for you to say this, just try living with MY child and see what you think. I think I can speak from experience as a parent and having to struggle with mind-blowing odd behavior in my adult child. Years ago, my elementary school aged middle child drove me to seek out a psychologist, who was very helpful in helping me to understand him. I changed my attitude and he changed his behavior. It’s a two way street. My youngest was inexplicably termed ADD by a psychologist who had never even seen him in action. Parents of young children are understandably under stress and sometimes don’t feel they have the luxury of taking a step back from the situation. Even in the 1990s, ADHD and ADD was the diagnosis du jour. Everybody seemed to have it.

Its one thing to be given the label, but it’s another thing to know what to do about it. And that’s where most of us fall down, knowing what to do about it. Science hasn’t been much help. More emphasis is needed on family therapy in learning how to deal with the surprising ways that children can react to their home environment. Especially that “rare” child.

Not sorry enough

Dr. Joseph Biederman, the popularizer of the bipolar child phenomenon, and two colleagues, have been called into the principal’s office by the Harvard Medical School and the Massachussetts General Hospital, and, gosh, they are very sorry. Instead of being publically drawn and quartered for accepting pharmaceutical money for promoting dubious research and misleading the public, they have been given the adult equivalent of writing on the blackboard 50 times (okay, once) that they are very sorry that they have brought Harvard and MGH into disrepute, and they will never do it again, or, at least, they will check with their employer first before they accept any more money from industry…  for a year. So, it’s Harvard and MGH that are “upset” about being in the spotlight, and we the public will have to continue to cyberstalk Dr. Biederman et al, until, what? But they are not apologizing for the hell they have wreaked on the public, to which this “apology” letter attests. (Thanks to One Boring Old Man via Stephany and for bringing this wrap-up to my attention.)

One Boring Old Man says that the evidence for the bipolar child is thin on the ground, and he demonstrates in his post how paltry the evidence is that the bipolar child hinges upon. “Over the course of the years between 2000 and 2008, Biederman’s group reported 9 clinical trials [among their 78 articles]. I included this table because I was surprised at how thin it was – seven small open label trials, one retrospective analysis [of someone else’s Janssen financed double blind study], and only one double blind trial of their own. With all the noise they were making, I would’ve expected more:”

We can fight back by continuing to agree from here on in that there is no such thing as childhood bipolar disorder, there never was, there probably never will be. Bipolar is a rare occurence, and was diagnosed only in adults until Dr. Biederman got going. What we have are children acting out. We also have children who act out in a myriad of ways as a result of being given a cocktail of pharmaceuticals that go along with this diagnosis or cause this diagnosis to happen in the first place. I said “acting out.” Head banging rage and talk of suicide is acting out, but try telling that to parents who feel that nobody understands their particular situation. This is not a discipline problem, they insist, my child is really ill. He has (Biederman inspired) bipolar. To which I would say, a problem is still a problem in need of a solution, but it isn’t bipolar.

Anger and irritability can take people’s breath away when a rare child gets going. (I was an extremely angry, irritable child who, if this happened today, might have been placed on an antipyschotic.*) It seems like a mental illness, it walks and talks like a mental illness, but is it a mental illness or is it a failure to understand how to help? Families aren’t getting the kind of help they need because Dr. Biederman and colleagues have sidelined psychological and nutritional support in favor of pharmacogical treatment. For years we have heard that talk therapy doesn’t work but really what was going on was that pharmacology paid more to the doctor, who had no incentive to speak well of the competition. So a real avenue of help has been trashed and it will take quite a while to right that wrong.

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*Holistic thought: I used to vent my spleen a lot, regularly, several times a day in fact. Anybody and anything set me off. For those not familiar with this expression, a spleen is an organ near the stomach that produces and cleanses the body’s blood.** To vent one’s spleen means Fig. to get rid of one’s feelings of anger caused by someone or something by attacking someone or something else. Jack vented his spleen at his wife whenever things went badly at work. Peter vented his spleen on his car by kicking it when it broke down.  There were two events that happened round about the same time that may have turned me into the sweet, good-natured person I am today (irony). When I was eleven years old my spleen was surgically removed. I also remember that just before Christmas, my mother grabbed me by the shoulders and said, in a very menacing tone of voice, that if I ruined one more Christmas for the family she was going to knock my teeth down the back of my throat! Two possibly unrelated events. Same outcome. I changed.

**Cambridge On-Line Dictionary

The latest threshold that psychiatry has crossed

Mommy, am I really bipolar? is the title of a Newsweek piece by Stuart L. Kaplan, M.D. Dr. Kaplan argues that there is no scientific evidence that bipolar disorder surfaces in childhood. Dr. Kaplan goes through the recent history of this diagnosis which began in the 1990s with the book The Bipolar Child, and he discusses how quickly psychiatry and the public rallied around this label. Judging from the force of the comments to this article, mainly all negative in regard to Dr. Kaplan’s opinion, there should be a huge blow coming to psychiatry’s credibility as it tries to backpedal on this diagnosis in children. Why should these parents believe psychiatry now?

As much as I agree with much of what Dr. Kaplan writes, there is a huge credibility problem that has been simmering along for the profession and could boil over. Since psychiatry has put all its efforts into magic bullets it has neglected to figure out how to relieve human suffering. In fact, it has gone out of its way to tell parents that it was dangerously old-fashioned to believe that maybe the family environment has a good deal to do with why the child is behaving in a certain way and that chemicals are the main solution. I would be all in favor of what Dr. Kaplan is saying, except that he undermining this position by further arguing that bipolar in children is most often ADHD, and psychiatry has chemicals to treat that. He also refers to ADHD as less trendy than bipolar. Maybe so now, but not so when my kids were in elementary school. ADD and ADHD was THE buzz with the mothers in the schoolyard. So, all Dr. Kaplan is doing is trading one diagnosis for another diagnosis that has the FDA ‘s blessing for the drugs that are used in children.

Many young parents don’t know what they believe themselves, so they believe their doctor. They believed their doctor, perhaps after initially putting up resistance (or perhaps not), when the doctor told them their child was bipolar. Now, all of a sudden, the same doctor is telling them that the child is not bipolar? How is the doctor going to explain away the drugs and the fact that their kid is still messed up? Why should the parent believe this latest fad un-diagnosis? You would think that a parent would be delighted to hear that their child is inattentive and hyperactive, rather than the more ominous bipolar, but that doesn’t seem to be what is happening with the parents who commented on this article. They are lining up behind the belief that their child is horribly, mentally ill and they don’t want the label dropped. By giving parents this option, psychiatry has created a much bigger problem that has invaded every nook and cranny of family life and parents want to hold psychiatry to it. They won’t be able, to, unfortunately.

Psychiatry should be in big trouble from these parents now that it is backpedalling on the bipolar diagnosis. Memories are short, however. The parents of under 18s now will not be the same group of parents of under 18s ten years from now. The bipolar label is going to be folded into a new label. I’ll let Dr. Kaplan explain the new think:

The tide may be turning. The American Psychiatric Association is deliberating intensely on new criteria that would dramatically restrict this fad diagnosis. One step the association is recommending is a new diagnosis called temper dysregulation disorder, a more accurate way of describing extreme irritability in children. If mental-health professionals can be persuaded to consider these alternative diagnoses, many thousands of children could be spared an unwarranted, stigmatizing label that sticks with them the rest of their lives.

The controversy over bipolar will fade, since there is a good chance the current drugs won’t get approved for use in children, anyway, and the next generation of parents will be snowed once again by the profession using new labels and different drugs.

For those who want off the merry-go-round, this latest controversy is all the more reason to rely on one’s own intuition, to expand one’s belief system, and look to emulate people who have cured themselves.

Misunderstood and then misdiagnosed

I do most of my thinking for this blog while I’m walking to and from work. The motion and fresh air stimulate my thoughts. As I walk, I ruminate about something I heard or saw the day before.

 The bipolar disorder satire that has been seen on so many blogs, the one where the computer animated woman keeps telling the shrink how crummy she feels on the medication and he keeps repeating that she needs the medication because she has “the bipolar disorder,” and it goes round and round from there. She tells him that she was feeling very upset because of a family tragedy when she was admitted to hospital and he says “that’s the bipolar disorder.”

What interested me recently about this clip was that the patient says she is on 10 mg of Abilify for “the bipolar disorder.” A few months ago I half jokingly told Chris (on 5 mg Abilify) he was depressed, not schizophrenic, because I discovered that Abilify was now being prescribed as an add-on treatment for depression. But he can also be bipolar, if that’s what he prefers, because Abilify is also for bipolar disorder. (A real wonder drug!) Who’s to say Chris isn’t bipolar? When he was first admitted to hospital, the doctors gave him only a 25% chance of being bipolar, but, as we know, doctors are often wrong, especially when it comes to psychiatric diagnoses.

Of course, I am being facetious, because the labelling is meaningless in the first place, but the blurring of diagnoses logically comes about because the same drug is used to treat supposedly different conditions. This is an open invitation to pick the diagnosis you would prefer to have. If a choice has to be made, wouldn’t a patient want to join the higher status group of people like Britney, Catherine and Mel, who supposedly don’t have schizophrenia, they have “the bipolar disorder.” Is it logical to claim that if you are no longer on Abilify, you no longer have the bipolar disorder/schizophrenia/depression?

Along the same lines of my muddled thinking on Abilify, here is an excerpt from Pamela Spiro Wagner’s blog, which relates how her friend  assumed that he was schizophrenic, based solely on the fact that he was prescribed Trilafon. The doctors never questioned this diagnosis once Joe told them what he was. They accepted what Joe told them as fact, without doing their own thinking. This is a very sad story, and unfortunately, it’s an all too frequent one.

I believe that Joe was misdiagnosed for many many years with schizophrenia, when in fact he had had Asperger’s from childhood. Now, that’s a long story in itself and though I could make a case for it, I cannot prove it. But I am not the only one who knew him well to notice that he never once exhibited signs of psychosis or even real delusions or true paranoia. Furthermore, from what I gather, the only reason the diagnosis came about or “took” was because he was put on Trilafon by a well-known psychiatric incompetent who was later “defrocked” and when Joe looked the drug up in the PDR and read what it was used for, he concluded that that meant he must have schizophrenia. From then on, so his story was, he told subsequent doctors this diagnosis, and apparently they simply took it on faith. In fact, for all the years thereafter until his terminal illness of ALS, the one doctor he saw not only never questioned this, but also never even reconsidered his absurd concomitant Dx as bipolar, even though Joe clearly had one of the most placid temperament possible and certainly wasn’t the slightest bit moody. No one so far as I know ever even considered that there might be something else going on. Even when I once went with him to see his non-medical therapist, did she really seem even to want to think about the possibility, as if it might be too much trouble…Perhaps, though I cannot recall, it was too late, if in fact this was after Joe’s ALS diagnosis.

But as I said, that is a long story, and not being a doctor, I suppose I can’t make the diagnosis, except that as his closest friend, I do and I feel that a great injustice was done. Not only was he saddled with a serious psychiatric diagnosis, and a stigmatizing one at that, but that particular neuroleptic medication rendered him much too tired to work as an engineer. All his adult life that was what he really wanted to do. Work. But the drug sapped his stamina…Worst of all, although eventually on Zyprexa which helped what might have been poor social skills due to Asperger’s, after he had been on it for years it caused the diabetes that ultimately cost him his life.

So what is schizophrenia? I’ll let Jung have the last word here. These are actually two quotes. I have added the second shorter quote to show how to cure a schizophrenic. (I like how he adds “provided one’s own constitution holds out.” How true!)

But even so one can bring about noticeable improvements in severe schizophrenics, and even cure them, by psychological treatment, provided that one’s own constitution holds out [in my own experience, I have had situations where I continued the long-term psychotherapy of several patients in inpatient state hospital settings, later transferred into my practice, in which I was physically attacked, reported to have sexually molested the patient , etc, to very positive outcomes, e.g., to the point where family thought their family member was originally misdiagnosed as schizophrenic, never having to return to the state hospital after many years of residing there, etc]. This question is very much to the point, because the treatment not only demands uncommon efforts but may also induce psychic infections in a therapist who himself has a rather unstable disposition. I have seen no less than three cases of induced psychoses in treatments of this kind.

A schizophrenic is no longer schizophrenic… when he feels understood by someone else.

– Carl Jung

The ties that bind

The excerpt below from the CNN article, Growing up bipolar demonstrates planting a certain belief (in this case “disease mongering”) by people who most stand to benefit. A quick Internet search revealed that Dr. Charles Raison’s Mind-Body Program at Emory University gratefully receives funding from:

Anonymous Donor Support; The Dana Foundation; The Emory-Tibet Partnership; Glaxo Smith-Kline; The National Heart, Lung, and Blood Institute (NHLBI); The National Institute of Mental Health (NIMH); NARSAD; Schering-Plough

Dr. Rakesh Jain is in private practice in Texas.

Is it possible to stop medication?

For the past year, Jennifer has been off of all medications but still sees a therapist, and the family has a relationship with a psychiatrist in case of relapse.

In general, people with bipolar disorder must stay on medication for life because relapses are common, said Raison, who has not treated Jennifer. But some are fine for periods of time without them, he said. (editor: Relapses are not common if you get your act together.)

Jain agreed that some patients who do well can go for stretches without medication, but he has never been able to completely remove a bipolar patient from drugs and say, “you’re cured.” Bipolar disorder should be viewed as a chronic illness like hypertension or diabetes, which require lifelong management, he said. It is wise for anyone who does go off medicine to continue to see a mental health professional and closely watch for symptoms of recurrence, Raison said.

See also another aspect of The ties that bind

“Nobody was on my side”

I sometimes bring up the idea that it is important to be on your relative’s side when a diagnosis has been handed down. I read the CNN article Growing up bipolar and glommed onto the following quote:

Jennifer, the middle child, was always the most sensitive of Konjoian’s three children, her mother said. She never had any episodes at school; they usually happened when she felt overwhelmed by her family: for instance, when her siblings picked on her.

“I felt like nobody was on my side. That’s kind of how I always felt,”

This child was given a label of bipolar (after initially taking an antidepressant, as is so often the case) and yet, here it is, in black and white, that her behavior was a problem at home, not at school. Her family was driving her crazy. She felt that they weren’t on her side. I can identify with this. As a child I was continually angry and lashing out, at home, never at school. It was my family that was driving me crazy and I didn’t learn coping skills  until I finally tired of myself and made a vow to stop. Naturally I felt nobody was on my side at the time.

Being on the person’s side, seeing life from someone else’s point of view, is huge in healing. Most parents are too busy settling disputes amongst siblings to really focus on the child’s point of view.

When we landed in the mental health system, after a while I began to wonder who was really on Chris’s side. It took me a while, but I finally realized that Chris’s perceptions were real, not something that should be dismissed as lunatic ravings. Okay, psychosis is an unusual way to express yourself, but for some people, it is the only way until they master a way of not retreating into psychosis. The doctors claimed they were on Chris’s side, but then they referred to him as a patient, they spoke of his delusions, they gave him drugs to sedate him. They encouraged a view of a limited future.

Parents can easily fall into the same trap and will take the side of the doctor, which is a negative and mechanical view of the individual. Ian and I cajoled Chris into taking his meds because the doctors said it was essential. We looked at Chris as if he was the crazy one. We were not on his side. We confused empathy with pity.

After a while I “got it.”  I decided Chris was right about whatever it was that was bothering him. He had justifiable cause. Chris’s way of expressing himself as a child was not like Jennifer’s. His way was quiet and non-confrontational. Everybody has their own way of dealing with anger or fear.

Why are we so eager to believe somebody else and not our relative when it comes to mental health issues?