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 Books reviewed are often textbooks that are relatively out of date by the time they are published because of the lengthy period between the time a book chapter is written (often several years) and the time a book is published.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.
The book review section of the Journal of the American Academy of Child and Adolescent Psychiatry ignited an unexpected controversy with the review of two books for parents of bipolar disordered children and adolescents: Positive Parenting for Bipolar Kids: How to Identify, Treat, Manage, and Rise to the Challenge and Bipolar Kids: Helping Your Child Find Calm in the Mood Storm. The books were reviewed by Jennifer L. Vande Voort, M.D. and Lloyd A. Wells, M.D., both of the Mayo Clinic (Journal of the American Academy of Child and Adolescent Psychiatry, 2011, 50 (May):525-526). After noting several positive features and some concerns about both books, Vande Voort and Wells offer the interesting recommendation that the books are best read by parents after they have had a consultation with a child psychiatrist to learn if their children have bipolar disorder. Drs. Vande Voort and Wells are concerned that the symptoms and behaviors described in both books are imprecise enough to lead uninformed parents to the conclusion that their child does has bipolar disorder when the child may not have the disorder. This might lead parents to approach a child psychiatric evaluation with an expectation or demand that the child receive a diagnosis of bipolar disorder. Drs. Vande Voort and Wells are concerned that the books provide a script for parents to follow in presenting a narrative of the child's difficulties to a clinician doing an evaluation, and that the scripted descriptions will direct clinicians toward a diagnosis of bipolar disorder that may not be warranted.
The reviewers conclude with the positive note, "with proper guidance from a mental health professional, parents may find that each book offers helpful advice and the reassurance that they need to not face their child's struggles alone."
The authors of both books responded to the reviews with some vitriol in the Letters to the Editor section of the November, 2011 issue of the Journal, pages 1186-1188.
The authors of Positive Parenting for Bipolar Kids : How to Identify, Treat, Manage, and Rise to the Challenge were strident in their denunciation of the review. They challenged the widely accepted position that bipolar disorder in children is overdiagnosed: "there is no empirical evidence that there is an over-diagnosis of bipolar disorder." They accuse the reviewers of belittling parents, comparing the reviewers to those in the past who espoused "refrigerator mothers" and "schizophrenogenic mothers" as the causes of children's illnesses. They accuse the reviewers of holding attitudes that would psychologically traumatize parents who were concerned that their children had bipolar disorder. The book authors incorrectly conclude that approval by the FDA of some medications to treat bipolar disorder in children is evidence that this disorder exists in children.
The author of Bipolar Kids: Helping Your Child Find Calm in The Mood Storm complained that Vande Voort and Wells did not seem to understand that the symptoms listed in her book were not meant to be precise examples of bipolar disorder but rather were meant to serve as examples of symptoms without reference to a specific disorder. Also she complained that the book review did not give parents enough credit for the ability to recognize the meaning of their child's symptoms.
In reply to the authors' criticisms, Vande Voort and Wells noted that the reviewed books will contribute to the overdiagnosis of the disorder and will continue to promulgate a diagnosis for which there is little professional consensus.
In the past, such books would have been reviewed quite gently. It is clear from these reviews that there will no longer be free passes for books related to child bipolar disorder. Books about bipolar disorder in children will likely receive more critical scrutiny from the book review section of the Journal.
This book review dispute provides an opportunity for a brief commentary about the role of advice books for parents of children thought to have bipolar disorder. These books have played a major role in promoting and disseminating the diagnosis of bipolar disorder in children. The all time best seller in child mental health is The Bipolar Child by Demitri Papolos, M.D. and Janice Papolos, which is in its third edition and has sold over 200,000 copies. Immediately surrounding its publication, its authors appeared on national TV shows such as 20/20, Oprah and the CBS Early Show. Steve Hyman, M.D., described meeting with parents clutching this book to plead with him to study the disorder at the time he was director of the National Institute of Mental Health( Groopman, J. What's Normal? New Yorker, Volume 83, 2007, April 9). There are approximately 30 additional books advising parents of bipolar children and supportive of the diagnosis.
If the parents concerned about the possibility of bipolar disorder in their child shouldn't be reading these books, what should they be reading?
Stuart L. Kaplan, M.D. is the author of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis.
copyright Stuart Kaplan, M.D.