In Practice

A practicing doctor's views on psychiatry and contemporary culture.

Bipolar Disorder: Not the Politics, the Experience

Why the Newsweek cover features a bipolar child

My beloved former producer from “The Infinite Mind, ” Mary Carmichael, has the cover story in the current Newsweek. “Welcome to Max’s World” represents a landmark, a major magazine devoting its cover — the banner reads “Growing Up Bipolar” — to a child who has not otherwise made news. There’s no sidebar on what the diagnosis means, whether too many kids get labeled and treated (and whether the pharmaceutical industry is to blame), or how parents can find help. Some of this information is in the essay; a good deal of it, in the modern fashion, is on line. (A overview of the biology of manic depression features top scientists speaking in sober fashion.) But mostly, the narrative carries the load. Mary spent five weeks with a family, the Blakes, and pored over their scrapbooks and their son’s medical records. What we see is a disturbed and disturbing — sometimes threatening or violent — child stumbling through daily life.

What does this mean, for a portrait of an unknown family to bear such a burden? I’m wanting, informally, to ask one of those “deconstruction” questions about a milestone for the mass media. Boiled down, I think that the story, and its prominent, isolated placement, says that mental illness is real, it’s devastating, it’s complex, and it’s larger than the political wars that simmer around it.

Should a pre-adolescent be medicated? I have a standard answer for this question: Hard cases make bad law. (Apparently this saying was already a commonplace when Oliver Wendell Holmes cited it in a decision in 1904.) What I mean is: We know that our medications and behavioral interventions should be better, but we also know that families can bear only so much, and that the harm mental illness does in a developing child is substantial. "Max has been on 38 different psychoactive drugs" — and we can see why. I am tempted to ask who would stand in judgment of the Blakes or their doctors, but perhaps a better way to phrase the question is: once we witness their struggle, don’t we all look on with admiration?

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. That’s the other theme of this distinctive magazine presentation, a stand-alone account of a single troubled child: science is progressing at an extraordinary pace, but in the face of these complex disturbances of mood, thought, and temperament, we all — parents, teachers, doctors, pundits — do well to remain humble.

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Peter D. Kramer is a psychiatrist and author. His books include Against Depression and Listening to Prozac.

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