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Where did the bipolar go?

June 11th, 2012

When she was four years old, my daughter received a diagnosis of mood disorder, and when she was six, a new psychiatrist diagnosed her with bipolar disorder. I will never know whether she received this diagnosis because I took her to a particular clinic at a leading medical center, or whether her constellation of symptoms truly fit that diagnosis.  The psychiatrist who gave her the bipolar diagnosis has been criticized in the media for over diagnosing children with bipolar disorder. A recent story in the Boston Globe describes the ongoing dispute within the medical field over whether chronic irritability and aggression symptoms of ‘mania’ or are better described in the upcoming DSM V as ‘disruptive mood disregulation.’ 

Children who are diagnosed with bipolar disorder often receive other diagnoses, including ADHD, oppositional defiant disorder, post-traumatic stress disorder, attachment disorder, executive function disorder, sensory integration disorder, and autism spectrum disorder. By the time my child was six years old, she had been hospitalized at least twice and diagnosed with all of the disorders listed above, and probably more.

For many years, I was convinced that her prognosis was very poor. In bimonthly meetings at the psychiatrist’s office, I learned that the early onset of my child’s extreme aggression, combined with the frequency of outbursts, pointed to a stronger likelihood that her illness would develop into adult bipolar disorder, as compared with children who had later onset or more mild symptoms. The few people whom I knew with adult bipolar disorder were unable to work and seemed quite disabled. When I argued that my child seemed neither ‘depressed’ nor ‘manic’, I was told that I was incorrect and that irritability was the hallmark of mania (and depression).

Since she was three, I have investigated and tried many interventions to address my child’s tantrums, aggression, social deficits, and hyperactivity, including sticker charts, Collaborative Problem Solving, multiple psychiatrists, therapists, and hospitalizations, at least 15 or 20 medications, two therapeutic schools, social skills groups, occupational and speech therapy, and more. Despite all of this, she attacked me many times, physically and emotionally, and was aggressive in public. Needless to say, she didn’t have any friends.

Nine months ago, the psychiatrist at a long -term psychiatric treatment program told me that I have to accept that my child ‘will never become a doctor or a lawyer’ because her illness is too severe.  This is a child who has expressed the desire to become a medical researcher.  I was outraged at the psychiatrist’s arrogance and I hope that she has a short career.

Fortunately for my daughter, she has a mother who never gives up.  During the Persian Gulf War (1990-1991), while living in Jerusalem, I learned to persevere in the face of uncertainty about the future. Despite the constant risk of biochemical warfare from a Iraqi missiles people went to work and carried on life as usual, carrying gas masks everywhere.  I learned to push aside the fear and the doubt and keep on trying.

After receiving the unwelcome prediction, 9 months ago, I decided that radical action was needed.  I discontinued the services that were not working or were making my child worse: the therapeutic day school and overnight camps, speech and occupational therapies and the antipsychotic medications.  I listened to my child when she said that she wasn’t being challenged at school, she didn’t need speech and OT, and she wanted ‘normal’ classmates. For an interim period, after withdrawing her from the therapeutic school, we tested the waters of reentry into the world of the non-mentally ill.  I home-schooled her and she gradually joined groups of home schoolers, then girls her age within our religious community. With each new group experience that she tried, I kept my cellphone close, in case her inappropriate behavior resurfaced. To my surprise, and joy, she made friends and discovered that her social skills not as inadequate as we had thought.

My daughter’s bipolar disorder seems to be gone. She is thriving at a private school, not special education. She is achieving high grades and is making friends.  Sometimes the experts are wrong.

Our guest blogger, Rachael Wurtman, is in private practice as an Mental Health and Autism Spectrum Advocate, who advises parents about and advocates for  interventions and services, at schools and in the community. She finds pediatric mental illness and autism spectrum disorder fascinating and is constantly learning as much as she can. She is trained in law and in child development and has chosen to give up the practice of law.

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