The Alleged Controversy About Childhood Bipolar Illness

Gag me with a spoon.

Psychiatric diagnosis is never a controversy. It is always a mess.

Within the first week of my residency training, my respected preceptor in child psychiatry told me “You aren’t going to child psych very much, Estelle. There isn’t much evidence for most of what we do. The research is about 20 years behind adult psychiatry.”

He was more than right.

I will admit I bucked and ran from the field, mostly because I was not much of a “natural born mother” type and all of the biological mothers of the patients seemed to hate my guts.  The way that children present can only be filtered by the way that adults see them.

We know enough about neurotransmitters now, that we just might be able to do highly sophisticated brain imaging and identify the neurotransmitter perturbations in various mental illnesses.

We don’t — and persist with descriptions of behaviors.

I have believed then, and still do, that a child’s diagnosis is generally a function of how much the child has managed to get the relevant adult angry at them.

Bipolar I and II cover a fairly large variety of territory. Adult patients are often mad at me when I call them bipolar because they think it means they are in some kind of danger of taking hostages and shooting up the post office.

I calm them down and tell them we can call the illness “kumquat,” which is an innocent little citrus fruit that would never hurt anyone. I even tell them I have seen some series suggesting this clump of allegedly bipolar I and II includes as much as 17% of humanity — and more than a couple of creative geniuses.  Maybe bipolar resolves after childhood in some folks. A respected colleague (who actually published with me at one time) from New Zealand has found some pretty wildly significant improvements in childhood behavior with supplementing for childhood nutrition.

I do know current medications for bipolar have enough side effects I would hesitate to prescribe them to a young child.

In adults, I am fairly convinced that being on an antidepressant medication can turn people into meeting our current classification for bipolar. About a quarter of them, according to recent research.

We are pretentious as a profession if we focus on classification at our level of knowledge about the brain.