The death of 4-year old Rebecca Riley has raised concern that Bipolar Disorder is being over diagnosed in children and treated routinely with dangerous medications. Of greater concern than the use of medication with children is the lack of appropriate psycho therapeutic care for both these children and their families. Rebecca may well have been properly diagnosed, but she and her parents needed more comprehensive psycho therapeutic care. (Click here to read The Boston Globe story about Rebecca’s case.)
The advances in the pharmacological treatment of bipolar disorder in the last twenty years are equivalent to those made with the use of antibiotics that took place sixty years ago. However, in psychiatry diagnoses are much more tentative because they do not yet include a full understanding of what takes place at a cellular level. Just as importantly, the treatment of psychiatric disorders includes vastly more than the use of medication. As psychiatrists we work with illnesses that become entwined with a person and with the person’s family.
Appropriate treatment of Bipolar Disorder in a child requires psychotherapy: personal expert care that addresses the problems the child has at home, in school, and with other children. In a child a psychiatric disorder crucially affects development at every stage. In treating children with Bipolar Disorder it is my experience that the developmental problems are ultimately more difficult to treat than the biologic ones. Without psychotherapy medication can become a hammer and the child becomes the nail. Without medication, however, psycho therapeutic care sometimes is not possible.
Bipolar Disorder is also an inherited condition, which means that a child with bipolar disorder may have one and sometimes two parents with the condition. Frequently enough parents are willing to give their child care they will not accept for themselves. An untreated mood disorder in a parent destabilizes the family, and the family is the crucial environment in which a child grows. Even when neither parent suffers from Bipolar Disorder, an affected child puts a great strain on a family. So, family therapy is a crucial part of delivering care to a child.
Bipolar Disorder is more frequently overlooked than over diagnosed. At present, most children with Bipolar Disorder—one estimate puts it at four out of five—go undiagnosed and untreated. Even when resources are not a problem it can take years before a child is properly diagnosed and treated. But resources are the greatest problem: in the midst of a biological enlightenment there is a dangerous tendency to minimize the importance of psycho therapeutic care. In most states and at the national level the insurance industry is permitted to treat psychiatric illness as a non-medical condition. Consequently, appropriate treatment—when it is available—is beyond the reach of families that need it.
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