A Note to Readers About This Blog
I have learned from some parents that they wish they had the opportunity to get my response to their comments on this and other blog formats. I am unable to do so, but want to make it very clear why this is the case. My refusal is based upon the American Psychiatric Association code of ethics which does not permit psychiatrists to comment on public figures or patients they have not personally evaluated or seen clinically. My compliance with this code can easily be misunderstood as an unwillingness to engage with my readers, and I want to make clear that nothing is farther from the case.
Book review sections in psychiatry journals are usually placid. The central agenda of most journals is the publication of original research articles; many psychiatry journals do not even have a book review section. Books reviewed are often textbooks that are relatively out of date by the time they are published because of the lengthy period between the time a book chapter is written (often several years) and the time a book is published. Wishing to review a particular area of the field, psychiatrists can find recent review articles easily in current journals. By reading journals, it is often possible to be a well informed psychiatrist without reading many psychiatry books.
“Drinking the Kool-Aid” is a metaphor used in the United States that means to become an unquestioning believer in some ideology, or to accept an argument or philosophy wholeheartedly or blindly without critical examination. The phrase can sometimes have a negative connotation, or can be used ironically. The basis of the term is a reference to the November 1978 Jonestown Massacre, where members of the Peoples Temple were said to have committed suicide by drinking a ‘Kool-Aid’-like drink laced with cyanide” (Wikipedia).
12 easy steps for professionals to misdiagnose child bipolar disorder
- 1. Ignore DSM-IV criteria for bipolar disorder
- 2. Make up your own criteria for the diagnosis of bipolar disorder
- 3. Believe that because one parent has bipolar disorder a child probably has bipolar disorder.
- 4. Assume that a child who is frequently angry is likely to have bipolar disorder.
- 5. Assume that a child who is depressed is likely to have bipolar disorder.
- 6. Interpret temper tantrums as mood swings.
- 7. Administer to your patient’s parents The Child Bipolar Questionnaire developed by Demitri F. Papolos.
Ellen Leibenluft, M.D. is an important exception to Upton Sinclair’s maxim, “It is difficult to get a man to understand something when his salary depends on his not understanding it.” As the Chief of the Section on Bipolar Spectrum Disorders at NIMH, she might be understood as having a vested interest in promoting the existence and study of bipolar disorder in children and adolescents. Instead, she has been a vigorous advocate for several major studies expected to lead to results that would significantly diminish the use of the bipolar disorder diagnosis in childhood. She provided the impetus for recent follow up studies in which chronically aggressive, irritable children were followed over time. Chronic severe anger and irritability in children and adolescents are the most frequent sources of the misdiagnosis of bipolar disorder in children and adolescents.
Although the DSM-V Child and Adolescent Disorders Work Group has rendered an invaluable service to the public by taking a critical stand against Pediatric Bipolar Disorder, disturbing signs of endorsement of the diagnosis are creeping back into the Work Group’s deliberations. Like a horror movie, just when we’ve been lulled into thinking our heroes have killed the monster, the monster comes back to life. In this post and several more to follow, I want to slay the monster completely. If good evidence for its existence cannot be found, pediatric bipolar disorder should be consigned to a museum of psychiatric fads rather than a place in DSM-V.
My book, Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis, describes the failures of organized psychiatry, the pharmaceutical industry and the media that led to the adoption and frequent diagnosis of a rare or nonexistent disorder. Making the diagnosis of bipolar disorder in youth proved harmful to the health of children and the reputation of psychiatry as a science. An important measure of the extent of the problem is found in the statistics of changes in diagnosis rates. Between 1994 and 2003 the percentages of mental health office visits for bipolar disorder in youth increased from less than half a percent (0.42%) to more than six and a half percent (6.67%), and between 1996 and 2004 the percent of youth leaving psychiatric hospitals with a diagnosis of bipolar disorder went up 400%!