by Kimberly Read
In 1999, Broadway Books released The Bipolar Child by Demitri Papolos, M.D., and Janice Papolos. I was thrilled with this book. In my initial review I called it "the shot heard round the psychiatric world."
At that time, I knew from firsthand experience just how little information and support was available for parents who were torn between struggling children and an unresponsive medical community. I also had a personal battle unfolding in my life. My discussion of Randy in the article Red Flags: Symptoms of Bipolar Disorder in Children is actually a reference to my son. (At the time, I choose to maintain his anonymity. I felt he needed to be old enough to make his own choice on publicly sharing his personal story.) So I didn't just read this book as a psychology student or journalist. Here was a resource that not only illuminated the difficulties my son was having, but also nailed down the obstinacy of medical professionals who were, as often as not, blaming me for his problems.
Research fields have been known at times to get mired down in their own rhetoric and dogma. It usually takes a controversial departure from well-established norms to get the wheels turning again. In my opinion, this is what The Bipolar Child did for child psychiatry (see Childhood Onset Bipolar Disorder (COBPD) - From Obscurity to Fame). The book became the focal point for a push that was gaining momentum and, as such, created some controversy.
Many researchers have concerns that this work was pushed to the mainstream and picked up by everyday folks like me and you before empirical research studies could adequately vet the theories put forward. Parents were armed with a list of symptoms that might or might not mean their child has bipolar disorder specifically or a severe mental illness in general.
Steven Hyman, a psychiatrist and former director of the National Institute of Mental Health, says that he saw a marked increase in parents seeking a diagnosis of bipolar disorder for their children -- parents who cited this book as the reason they sought psychiatric help. He comments that "the first parents who visited me came with the Papolos' book in hand."
Barbara Geller, a psychiatrist and researcher who has long believed in the reality of early onset bipolar disorder, started a second opinion clinic for pediatric bipolar disorder. She also comments on some of the difficulties she has seen because of this book:
Following the publication of the Papolos' book, we began to have a greater influx of people into the clinic. The positive effect of the book was that parents realized it was ok to take their kids to a child psychiatrist. At the same time, the book could lead to false diagnoses. In the clinic, the first question we have learned to ask of parents is "Have you read the Papolos' book?" (Groopman, 2007).In my son's case, we reached a point where I knew he needed a psychiatrist. Ironically, I was dealing with this from the other end of the spectrum noted above. I had actually put off taking my son to a psychiatrist for some time. I was worried he would be pigeonholed into a diagnosis because his father has bipolar disorder. And to be frank, I was also worried that my everyday involvement with the topic of bipolar disorder could mean I was seeing BP symptoms in my son because I expected to see them -- Medical Student Syndrome by proxy, so to speak.
During the first appointment with my son's new psychiatrist, I was open and shared my fears. From the get-go I feel we established a team comprised of all of us -- me, my son and the psychiatrist.
- I agreed that I would report my observations of my son's behavior and difficulties without extrapolating these to a diagnosis.
- I also agreed that my son could share openly with his psychiatrist and that I wouldn't pry for details of their personal sessions.
- My son agreed to try the behavior changes that were suggested, such as the tools to manage his anger. And he agreed to take medications.
- The psychiatrist agreed that she would respect my input and decisions, such as not pushing antidepressants. I felt strongly against this option because antidepressants had caused a psychotic break for my son's father, and I had spent several months painfully withdrawing from an SNRI.
There are times when I feel certain I am seeing manic behavior such as rapid, pressured speech and grandiosity. However, my son's symptoms are well-managed on his current medication (the arsenal of medications is pretty much the same regardless of the specific diagnosis). He excels in school and is as well-adjusted as any teenager can be. A formal diagnosis of a mental disorder was important for requesting needed accommodations in school via a 504 plan, but it wasn't necessary that the diagnosis be a specific diagnosis.
The point here is balance. So many families, due to lack of knowledge or fear, are living in war zones caused by mental illness in one or more of their children. For years we have dealt with medical professionals who consider these issues to be more parenting and behavioral problems. However, the tide has slowly but surely been turning with more disorders now been recognized and accepted in children. A couple of decades ago we witnessed the ADHD phenomenon and now bipolar disorder.
I think this offers an important cautionary note for us -- the everyday consumers and patients. We absolutely must be our own advocates and advocates for our loved ones. We need to be educated and well-informed about the issues surrounding our health concerns. We can and should question those who are our healthcare professionals, but this relationship needs to be a partnership. It is the balance between professional perspective and personal experience that will achieve the best outcomes for our children.
Source: Groopman, J. (2007, April 9). What’s normal? The New Yorker.
