Two Psychiatrists On Newsweek's Bipolar Child

Recently, Newsweek had a cover story on a young kid diagnosed with alleged bipolar disorder. I've already ripped the piece apart. I felt it failed to deal with the lack of evidence for the disorder in children and didn't even bother to quote critics within psychiatry of the controversial diagnosis. It lacked the level of balance I would've expected from the magazine.

My views, of course, are one thing. Those of psychiatrists are another thing entirely. Last week, Peter Breggin, a critic of much of current psychiatry who happens to be a psychiatrist, was a bit over the top when he wrote that psychiatry had declared "war" on the boy, Max. I understand his frustrations, but war is a bit much. Then he makes an extremely valuable point about what this boy, who's been on 38 different meds, and his parents will be up against:

"From now on, Max, his family and his doctors will almost certainly have to face an increasingly impossible dilemma common to children who are prescribed multiple psychiatric drugs for a period of years. When trying to withdraw these children from multiple psychiatric medications, they almost certainly go through severe withdrawal problems with extreme emotional instability and the risk of worsening violence and suicidality. In fact, we are told that an attempt to take Max off his medications resulted in his displaying hallucinations and delusions, which Newsweek attributes to his worsening condition and his need for drugs. The odds are overwhelming, instead, that he went through a severe withdrawal reaction. So it can be very difficult to withdraw children like Max from multiple psychiaric drugs, but if they are kept on drugs indefinitely, their brain, mind and overall condition is almost certain to deteriorate."

Regardless of what you make of the bp kids paradigm, Breggin is precisely right about withdrawal problems and that some of this kid's symptoms could well be generated by a reaction to medication withdrawal, or to the meds themselves. Maybe he magazine will do a follow up article someday.

I was intrigued by Peter Kramer's views on the article on his blog at Psychology Today. Kramer is of course the author of Listening to Prozac, which just passed its 15th Anniversary in print, a stunning accomplishment, regardless of what you think of the book (my views are mixed). Kramer, who globally seems to like the article, raises an interesting point:

"A note regarding diagnosis: Yes, the Newsweek text and headlines are pitched to an interest in bipolar disorder, but who knows what this kid has? Mary writes that Max’s secondary symptoms include hyperactivity, anxiety, obsessionality, attention deficits, dyslexia, and pronounced elements of oppositional-defiant disorder. A current movement in psychiatry favors “dimensional” diagnosis, cataloging scattered problems rather than grasping for syndromes. This trend can be taken too far, but especially in the case of children, whose disorders are often protean, the approach can signal an appropriate agnosticism."

His subtle point is that he thinks the magazine shouldn't have pushed the bipolar angle on this kid so hard because "who knows what this kid has." I wish the magazine had been a bit more sensible as well, given the many controversies in the field over this matter. It's clear that something is up with little boys like this, but what it is no one really seems to know with anything approaching certainty.

For those of you who want to read the thoughts of a defender of the disorder in kids, you can do no worse than John McManamy's post over at Health Central. He's been an extremely harsh critic of anyone who questions bipolar disorder in children, and his tone is often one of religious conviction. I've noticed that tone to be consistent in late-diagnosis bipolars, as McManamy is. You've got to wonder what's driving that.

Maybe he can take on Breggin and Kramer now.