In December 1999, Demitri Papolos, M.D., and Janice Papolos published The Bipolar Child, the book that convinced Anne that her son William was bipolar. In the preface, the authors lay it on the line for us: "Many of these children were initially diagnosed as having attention-deficit disorder with hyperactivity and put on stimulant medications; or they were first seen in the throes of depression with little or no consideration of the opposite pole of a mood disorder. As a result, a shocking number of children were thrown into manic and psychotic states, became paranoid and violent, and ended up in a hospital--unstable, suicidal, and in worse shape than before the treatment began...Parents need to be warned of the possibility that these drugs may wreak havoc on a possible quiescent bipolar gene."
The solution proposed by the authors is not to refrain from giving children powerful, brain-altering drugs in the first place, but to make sure they get the right drugs: "[M]ood-stabilizing drugs such as lithium, Depakote, or Tegretol should be considered as a first line of treatment--early on--before episodes become more frequent, and the illness warps the psychological development of a child and the life of a family."
The authors describe parents of bipolar children as "walking on eggshells" around their progeny--a bit ironic, given their own efforts to tiptoe around the role of psychopharmacology in creating this condition. Chapter One of the book describes an iatrogenic epidemic of staggering proportions. The authors tell us that 25% of all children prescribed stimulants for ADHD go on to develop bipolar disorder, then add "Since close to 4 million children were prescribed stimulants such as Ritalin in 1998, that's over 1 million children who eventually will be diagnosed as bipolar." They also note that fifty percent of children diagnosed with depression go on to become bipolar. And yet, just a few pages later, after noting that the age of onset of bipolar disorder has been plummeting for years, they state "While there are many theories attempting to explain this 'cohort phenomenon,' little is actually understood."
The authors describe children caught in the grip of explosive rages that can go on for hours--kicking, hitting, punching, breaking things, and screaming foul language and ugly threats. A three-year-old told his nursery school teacher "My father is going to come in and put seven knives in your throat." Another child told his teacher "I'm going to put a rope around your neck and pull it till you bleed and your face goes white and your shirt is soaked with blood." These stories are truly heartbreaking, but the authors never mention whether any of this vile behavior occurred before these children were given psychiatric medications.
In Chapter Two, the authors warn parents of dire risks of leaving bipolar disorder undiagnosed and treated: "Suicide rates for bipolar disorder have been estimated to be as high as 15 percent." No source is cited for this astonishing statement, nor do they provide any data that show that "treating" (i.e., drugging) these children decreases the likelihood of suicide. At the time this book was written none of the drugs commonly used to treat bipolar disorder in adults had been approved for use in children under the age of ten. They also quote Dr. Joseph Biederman, director of the Pediatric Psychopharmacology Unit of Massachusetts General Hospital, who likens untreated bipolar disorder to metastatic cancer.
The next chapter offers parents detailed instructions on how to obtain a diagnosis of bipolar disorder for their child. The authors provide a list of clinics at major teaching hospitals known for their pioneering work in pediatric bipolar disorder. First on the list is the Pediatric Psychopharmacology Unit at Mass General, headed by Dr. Biederman. Later on the authors advise parents, before retaining the services of any physician, to make sure he or she is familiar with Biederman's work. And in Chapter Six, "The Genetic Aspects of Bipolar Disorder," they take seventeen pages to tell us that despite all the money and brainpower thrown at this particular problem, researchers have yet to identify any genes for bipolar disorder, quiescent or otherwise.
The following year, the 17 July issue of the Fort Worth Star-Telegram featured a story on children diagnosed with mental illness, including two toddlers labeled bipolar. At the age of eighteen months, Heather Norris of Hurst, Texas began throwing temper tantrums, on one occasion banging her head against a car windshield so hard she broke the glass. She was prescribed Ritalin, which, in the words of the article, "sent her through the roof." When Heather was two years old, her mother obtained a copy of The Bipolar Child. Heather's mother took her to a psychiatrist who decided the child was indeed bipolar, making Heather Norris the youngest child in Tarrant County with that diagnosis.
Bryan Thompson of Granbury also was diagnosed with bipolar disorder at the age of three, again in the words of the article, "after he began taking Ritalin and his behavior grew worse." He frequently threatens to kill himself and his mother is quoted as saying "I know it will be like this for the rest of my life."
The article tells us "The earlier a problem is treated, the better chance a child had of living a healthy productive life." Not a shred of evidenced is adduced in support of this assertion.
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The 19 August 2002 issue of Time featured the cover story "Young and bipolar," which documents the rise in juvenile bipolar disorder sweeping the nation, along with this shocking fact: "The average age of onset has fallen in a single generation from the early 30's to the late teens." Fortunately, the article explains, help is on the way: "Genetic researchers are combing through gene after gene on chromosomes that appear to be related to the condition and may offer targets for drug development. Pharmacologists are perfecting combinations of new drugs that are increasingly capable of leveling the manic peaks and lifting the disabling lows...There are numerous atypical antipsychotics out there, including Zyprexa, Risperdal, and Haldol, and many are being used to good effect on bipolar patients."
The article gives no consideration of the role of the psychopharmaceutical industry in creating the epidemic, and winds up with a list of famous artists and writers--Lord Byron, Edgar Allen Poe, Robert Schumann, Vincent van Gogh, Virginia Woolf, and Ernest Hemingway--all of who supposedly had bipolar disorder.
For the record: as Ernest Hemingway was nearing the end of his sixth decade of life, his family and friends became increasingly concerned about his well-being. His body was failing him after decades of hard living, including injuries sustained in two plane crashes, and he was ingesting a cocktail of psychoactive drugs including methyltestosterone, reserpine, glutethimide, Seconal, and Ritalin. He became convinced the FBI was following his every move, a belief those around him regarded as delusional and paranoid (in fact he was being monitored by the FBI). On 30 November 1960 he checked himself into the Mayo Clinic where he received a course of eleven electroshock treatments. Afterwards, he lamented to his pal A.E. Hotchner "What is the use of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient." He became violently suicidal and checked himself back into the Mayo Clinic where he received more electroshock treatments, and subsequently blew his brains out with a shotgun.
As for the other luminaries named in the article, the piece is silent as to whether the world would be a better place if any or all of them had availed themselves of the services of modern-day psychiatry.
Next: Part 5: "Major therapeutic advances"List of Sources
Papolos, D. and J. Papolos 1999. The Bipolar Child. Broadway Books.
Brooks, K. 2000. No small burden: Families with mentally ill children confront health care shortcomings, undeserved stigma of 'bad parenting.' Fort Worth Star-Telegram 17 July 2000.
J. Kluger and S. Song 2002. Young and bipolar. Time 19 August 2002.
Hotchner, A.E. 1966. Papa Hemingway. Random House.
Meyers, J. 1985. Hemingway: A Biography. Harper & Row.
Reynolds, M. 1999. Hemingway: The Final Years. W.H. Norton & Company.
