New York Times Article on Bipolar Kids

Perhaps because I’m a fan of Jennifer Egan’s fiction, I wasn’t quite as annoyed by her article in the Sunday magazine as I thought I’d be. As I mentioned last week, the artwork is preposterous, the kind of images stories about “madness” always engender. The kid looks like he’s going to tear someone apart. Ooh. Scary. Children of the Corn.

But I was grateful that she gave time to the question of whether bipolar disorder is a legitimate diagnosis. Emphasis is all mine below:

A study last fall measured a fortyfold increase in the number of doctor visits between 1994 and 2003 by children and adolescents said to have bipolar disorder, and the number has likely risen further. Most doctors I spoke with found the “fortyfold increase” misleading, since the number of bipolar kids at the beginning of the study was virtually zero and by the end of the study amounted to fewer than 7 percent of all mental-health disorders identified in children. … Still, nearly every clinician I spoke to said that bipolar illness is being overdiagnosed in kids. … Breck Borcherding, a pediatric psychiatrist in private practice in the Washington area, said: “Every time one of my kids goes into the hospital, they come out with a bipolar diagnosis. It’s very frustrating.”

There are many possible reasons for the sudden frenzy of pediatric bipolar diagnoses. First, a critical shortage of child psychiatrists, especially in rural areas, means that many children are being seen by adult psychiatrists or — more often — by family doctors, who may lack expertise in child psychiatry. Managed care usually pays for a single, brief psychiatric evaluation (and it strictly limits the number of therapy appointments a year) — not nearly enough time, many say, to accurately diagnose a condition in a mentally ill child.

Then there is “The Bipolar Child,” a successful book published by the psychiatrist Demitri Papolos and his wife, Janice, in 1999, and referred to by more than one parent I spoke to as a “bible.” The Papoloses’ description of pediatric bipolar disorder was amassed partly by using responses to an online questionnaire filled out by hundreds of parents on an electronic mailing list …. The Papoloses’ diagnostic criteria include some idiosyncratic items — a severe craving for carbohydrates, for example — that are found nowhere in D.S.M.-IV. Nevertheless, many parents walk into doctors’ offices having already read “The Bipolar Child” and concluded that their children are bipolar.
…

And of course, there are pressures and blandishments from the pharmaceutical industry, which stands to profit mightily from the expensive drugs — often used in combination — that are prescribed for bipolar illness, despite the fact that very few of these drugs have been approved for use in children.

This is about halfway through the article, after a far too lengthy portrait of a kid with what has been diagnosed with bipolar disorder, but two years ago would be called Oppositional Defiant Angry Pissed-Off Disorder, or something. Time and again in this article, children are subjected to the diagnosis without merit. Even a parent wonders if she’s been misremembering details, and therefore had her kids misdiagnosed.

My takeaway is that Jennifer Egan doesn’t buy bipolar in so many children, though she does believe that mental illness is biological and can occur in children too.

My standards for this article were pretty low. I expected it to be horrible, like the Newsweek piece, but it was less horrible, so I got excited. Philip Dawdy, at Furious Seasons, posted a 12-point response to Egan’s piece, which he says “was, in my opinion, incomplete and, at times, deeply flawed.” For Dawdy’s reaction, which is extremely valuable in correcting the record, go here.

liz | 10:56 AM | Uncategorized