Angell believes the pediatric bipolar diagnosis has become commomplace in large part due to the advocacy of pharmaceutical companies, which have lined the pockets of leading psychiatrists. The doctors, Angell suggests, are only too happy to bolster psychiatry’s status by embracing drug therapy instead of talk therapy, which, after all, any old social worker or psychologist can provide.
It is terrifying to read about the drug cocktails doctors routinely prescribe to such children, which include powerful anti-psychotic medications developed for adults, such as lithium, Rispardel, and Abilify, as well as anti-seizure and high-blood pressure drugs, such as Depakote and clonidine, that also have mood-stabilizing effects.
Many of the medicines have serious side effects, including obesity and diabetes. And many children diagnosed with pediatric bipolar disorder never try tamer drugs, such as Ritalin, because proponents of the diagnosis believe such stimulant medications could exacerbate these children’s manic episodes.
As persuasive as these pieces of journalism are, however, I think it’s important to put them into dialogue with the often-desperate stories of the families whose kids are given such diagnoses. The must-read article is Jennifer Egan’s 2008 Times Magazine cover story on pediatric bipolar disorder. Egan met a boy who routinely beat and terrorized his younger sister; a girl who exhibited sexual interest in strange men as a mere toddler, and who beat her brother until welts formed; and a boy who told his mother he would commit suicide if she didn’t buy him a lottery ticket—and then ran into oncoming traffic. One mother, who eventually sent her bipolar son to a residential school in order to protect her younger daughter, told Egan, heartbreakingly:
“I used to cry five times a day, and now maybe I only cry once or twice. … So it’s better, you know? It’s better now that I don’t pick him up at school, and he doesn’t rage at me in front of all the other parents. He can rage when he bursts in the door, so no one sees how awful it is. It’s like a dirty little secret. It’s like having a husband who beats you, only it’s a kid. It’s your own.”
It’s no wonder the mother felt shame. As common as it has become to drop into a weekly therapy session, especially during times of personal crisis, there remains a powerful bias in American culture against mental illness and against aggressive drug-therapy for painful conditions seen as primarily emotional, hormonal or social in origin.