It is a sad reality of contemporary American psychiatry that many clinicians do not have the time or appropriate training to talk and listen to patients. Instead they are quick to assign the diagnosis du jour, which is often stunningly incorrect, and implement the corresponding treatment, with disastrous medical and psychological consequences.
Every Tuesday I teach a seminar with my colleague, Tim Dugan, MD, another child psychiatrist and psychoanalyst. We provide consultation and teaching to the staff and trainees of the child and adolescent psychiatric inpatient units of one of the Harvard teaching hospitals. Repeatedly we are aghast at the inappropriateness of the diagnoses children carry upon admission to the hospital. Tim has designated this phenomena the “biologization of suffering”. One favorite diagnosis is Bipolar Disorder.
Children are frequently diagnosed with Bipolar Disorder if their mood is unstable and they are unable to manage their feelings appropriately. They may exhibit a variety of symptoms and behaviors: aggression, trouble sleeping, attentional problems, hyperactivity, anxiety, depression, law breaking, defiance, self-injurious behaviors, suicidal threats or actions, or grandiosity (which means they are acting like they are all powerful and invincible), all as an expression of how deeply they are suffering and how helpless and overwhelmed they feel.
Their compromised mental state and dysfunctional behavior is the result of a variety of factors, prominently trauma, neglect, abuse and loss, often against a backdrop in the home and neighborhood of poverty, violence, mental illness, substance abuse, and the standard American diet. A hospitalized child has insufficient psychological skills to manage their feelings of anxiety, rage and grief. Instead of linking the home, school and social milieu with the presenting symptoms, they are given a biological diagnosis of Bipolar Disorder. It is as though their disturbed state is not a response to their experience of their families and environment.
A diagnosis of Bipolar Disorder commonly results in the prescription of a several powerful psychotropic agents, many of which result in weight gain, and some of which induce metabolic syndrome, and even diabetes in children and adults. In addition these medications frequently cause decreased energy and sexual dysfunction. Often additional medications are prescribed to treat the side effects from the original agents.
Not surprisingly, in July 2011 an influential Harvard Medical School faculty, famous for his research and teaching about the diagnosis and treatment of Bipolar Disorder in children, was sanctioned by Harvard for not disclosing over a million dollars in fees by the pharmaceutical companies. The same story is unfortunately familiar to us in many different industries today. Powerful corporations motivated by profit, manipulate the consensus reality, and disseminate disinformation that has nothing to do with science or public health.
It is imperative that this dangerous trend of medicalizing natural and normal responses to experience be recognized and reversed. The current practice of making psychotropic medications the centerpiece of treatment is misguided and dangerous, particularly to vulnerable populations like children.