Bipolar Disorder
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Depression: Major Depression & Unipolar Varieties
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by Demitri F. Papolos MD and Janice Papolos
Broadway Books, 1999
Review by Joy Ikelman on Sep 8th 2000

The Bipolar ChildNote: The reviewer has a diagnosis of bipolar disorder, and was a bipolar child. She uses examples from her own life experiences to explore the themes of the book.

Overall Rating: Five stars (out of five)

Target Audience: Parents of children diagnosed with bipolar disorder. Also recommended for adults with bipolar disorder and medical professionals who treat children with bipolar disorder.

20/20 Insight

In January 2000, ABC News 20/20 scheduled the first prime time television segment addressing The Bipolar Child. Since I had not yet read the book, I was looking forward to the program. Perhaps I would gain insight into my own childhood struggle: inconsolable depressions, endless racing thoughts. Sensitivity to light, sounds, and touch. Reactive, quick to tears. Near mystical states. Unusually creative. Overly anxious. I was a very, very happy child at times. I was a very, very sad child, too.

The 20/20 segment was horrific. The children were shown as angry, violent, and aggressive. They broke things, threw things, hurt themselves, and threatened to kill their mothers. They were hyperactive, mean, and out of control. Would this be the theme of The Bipolar Child?

Dr. Papolos, commenting afterwards on an ABC online chat, said, "Unfortunately, the piece that aired focused on the violent behaviors of people with bipolar disorder. There is a wide spectrum. Many do not exhibit this type of violent behavior." I would clarify this by saying most bipolars do not exhibit violent behavior.

How the Book Presents the Bipolar Child

"Rages and explosive temper tantrums lasting up to several hours," "marked irritability," and "oppositional behavior" are only three of the more than 40 "Common Symptoms of Bipolar Children" which are listed in The Bipolar Child. (Most of the other symptoms are not quite as dramatic.) Throughout the book, these seem to be addressed again and again. Why? Because these are the most pernicious. These behaviors are the least understood, and the hardest to treat. Early onset bipolar disorder often presents as rapid cycling mood swings, accompanied by frightening, erratic behavior.

The Papoloses wanted the reader to know for darned sure that the realm of early onset bipolar disorder is a medical topic. It is not bad parenting, or growing up in a socially degenerate, vacuous culture, as decades of behavioral psychology would have us believe. Early onset bipolar disorder is serious stuff.

Diagnosing Children

Media reports tell us that kids are over diagnosed with psychiatric disorders and are on medications that they don't need. Reality is a lot more complex than this. It is doubtful that any parent wants her child to have a diagnosed mental illness. It is also doubtful that any parent wants to over-medicate her child. Let's give the parents some credit.

Parents try everything they can before going to a doctor to discuss their child's mental health. They go to the family doctor first, who then recommends a psychiatrist for a consultation. They discover that their medical insurance does not cover mental illnesses, or expensive psychiatric medications. Still, the parents are determined to find out what is wrong.

The American Psychiatric Association's Diagnostic and Statistical Manual (DSM) is used to diagnose adults, not children. Because of this, the psychiatrist will do a best guess, usually settling on Attention Deficit Hyperactivity Disorder (ADHD) rather than bipolar disorder. Many of the symptoms overlap.

Unfortunately, misdiagnosis can have devastating effects. Dr. Papolos warns the reader that ADHD medications and antidepressants can induce manic episodes in children who actually have bipolar disorder instead of ADHD. The Bipolar Child does an excellent job of presenting information that doctors need to make an accurate diagnosis of bipolar disorder versus ADHD or other disorders.

Treatments

The Bipolar Child addresses the physiology of bipolar disorder and the role of genetics. The chapter on treatment is the best I've ever read in a book on bipolar disorder. It describes (in plain language) the medications, plus common side effects. It is the most up-to-date information available.

As a child (in the early 1960s), I spent a lot of time visiting Doctor Johnson, our family doctor. He couldn't figure out what was wrong with me. I was a well-behaved youngster who rarely got angry. However, I was overly emotional, easily excitable, hyperactive, very intense, and prone to panic attacks and tachycardia. I couldn't get to sleep, nor stay asleep. I had night terrors. I was exhausted all the time.

Doc Johnson prescribed paregoric and quinidine for me. Paregoric, someone told me recently, is an alcoholic solution containing opium. Quinidine is an antiarrythmic (used to treat heart conditions). Doc Johnson guessed at the dosages, and told me, "This will help to slow you down." I was seven years old. The medications didn't help with the racing thoughts, depression, anxiety, or insomnia, but it was the best the Doc could figure. I took these medications until I went to college. "You'll grow out of it," the Doc said. Well, I didn't. Right on schedule, in my mid-twenties, I met the official DSM criteria for Bipolar I.

The choices doctors have for today's bipolar children are extensive. The Bipolar Child emphasizes that early, proper treatments may prevent worsening of bipolar disorder. Although treatment remains an inexact and frustrating process, things are getting better. Still, I'm sure most psychiatrists feel much like Doc Johnson, who wondered how many spoonfuls of paregoric a very young child could tolerate.

Common Sense and Good Ideas

There is plenty of good stuff in The Bipolar Child for psychologists and therapists, too. This book is not just about medical theory and prescription medications, it is about adapting, coping, and dealing with the symptoms of bipolar disorder. (Studies have shown a much higher success rate when therapy is combined with medication compliance.) The book also gives practical information on working within the mental health care system, understanding insurance plans, hospitalization, and dealing with nosy neighbors. Plus, there is a whole section devoted to a bipolar child's educational life, and the need for an Individual Educational Plan. The common thread among all the pearls of wisdom is the Scout motto: BE PREPARED.

What's Missing in the Book?

This book is a mainly about children younger than twelve. I also get the overall impression that this book is about boys. What about girls and their unique problems with mood disorders? How about the very depressed children? How about the ones that don't throw tantrums but cry quietly when no one is looking? How about the daydreaming, sensitive, and isolated kids? And those who are paranoid, sleepless, having nightmares, migraines, anxiety?

What happens when these kids reach the magic age of puberty? There was a chapter on the topic, but it was incomplete. The authors addressed substance abuse and hypersexuality, which certainly may be a problem with some bipolar kids. But where was the discussion of the bipolar teen's suicidal thoughts? How about self-injuring, cutting, and eating disorders? What about self image because of weight gain from meds? How does it feel when your self-confidence is so low that you are afraid to date? There is enough material for another book. Might I suggest the title The Bipolar Teen.

Finally, where was a much-deserved section on the successful, creative, and bright kids? How about the ones who are coping well, seeing changes in their own young lives, and celebrating life? Let's hear from the kids.

Courageous Kids, Courageous Parents

Bipolar kids are courageous kids. It is no fun to experience rapid mood swings when you are a child. It is confusing, embarrassing, and mostly unpredictable. You feel guilty for letting your parents down. You feel bad for things you did when you were rageful, even though you didn't mean to do them. And depending on the reaction of your parents, you may feel like a failure, or a bad kid. You can't tell anyone you are suicidal, so you only let out clues.

Parents of bipolar children are heroes, fighting every step of the way to deal with bipolar disorder. They ache for their little ones. They feel very alone in their struggle. They love until their heart breaks. They may see their boy or girl destroy possessions, shatter relationships, hurt themselves, or even attempt suicide.

The Bipolar Child is dedicated to these courageous boys and girls, and to their parents who are trying to make sense out of all of this. The book is ultimately about love and how to move into action to save one life at a time.

Web Resources:
The Bipolar Child Web site

Parents of Bipolar Children

Child & Adolescent Bipolar Foundation

Pendulum Resources

Joy Ikelman's Bipolar Info

National Alliance for the Mentally Ill

Joy Ikelman has worked as a scientific writer and editor for more than twenty years. She has a B.S. from Concordia College, Nebraska, with additional coursework from the University of Colorado. She is published in the fields of geophysics and the history of science. Joy has also written newsletters, book reviews, and press releases while participating in various community organizations. Her favorite activity is enjoying quiet time with Ike, her sweetheart of 22 years. Her interest in mental health preceded her own diagnosis with bipolar disorder. Philosophically, Joy believes that knowledge is power, and that a patient with any illness has a fundamental right to question, learn, and contribute.