Bipolar in the Media

John McManamy Health Guide
  • Last night I arrived home from a conference just in time to catch Katie Couric being as stupid as Oprah.


    Readers will recall that Oprah devoted an entire show to bipolar, nearly half which featured a mom who killed her six-year-old son while in a psychotic state. (See my recent blog.) Then she talked to an actor and an actress for the rest of the show, and sandwiched Kay Jamison in the middle for two minutes, plus a very quick wrap-up.


    Watch out for people with bipolar, was Oprah's message. People with bipolar kill their kids. She used the word, crazy, more than once.


    "Sixty Minutes" would never stoop to such levels, I thought. They set the standard for TV investigative journalism.

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    "What Killed Rebecca Riley?" read the magazine set behind Katie Couric.


    "On Dec. 13, last year," Ms Couric intoned, "police responded to a 911 call and found a little girl lying dead on the floor next to her parents' bed."


    Oh, oh.


    Katie Couric continued: "The autopsy revealed that she had died from an overdose of psychiatric drugs. Rebecca Riley was being treated for bipolar disorder, or manic depression, even though she was just four years old."


    The New York Times broke this story in February of this year. Other media outlets picked up on the story, while antipsychiatry bloggers chortled with glee.


    Some background: For years, parents of kids with bipolar have been fighting battles reminiscent of the first generation of NAMI parents. Back in the bad old days, psychiatrists blamed schizophrenia on bad parenting. Mothers were simultaneously lectured to love their kids more and discipline their kids more. Then the schizophrenia would go away.


    Parents of bipolar kids have been getting the same treatment. Recently, thanks to books such as "The Bipolar Child," and the establishment of organizations such as the Child and Adolescent Bipolar Foundation, parents have been able to make headway with their clinicians and the school system. Many of these kids, and their families, now have hope in their lives.


    Thanks to the sensationalism surrounding the Rebecca Riley tragedy, however, we now see the revival of stupid talk about child bipolar being a fad diagnosis, and that it is overdiagnosed. Worse, so-called pundits are claiming that what is being called bipolar is just normal child behavior.


    Is the following normal child behavior? (from "The Bipolar Child"):


    "One day, after [mother] Melissa refused to buy him candy, Eric [kindergarten age] ran out of the grocery store and attempted to run across the street. A few times he attacked her - hitting, kicking, and biting. Once, when sent to his room for a time-out, he opened the second-story window, knocked out the screen, and threatened to jump. Later he told his mother he thought he could fly."


    "Did you ever think," Katie Couric goaded the mother of Rebecca Riley, "'Well, she's two and a half years old.' There's this thing called the terrible 2's. Did you think this could, in fact, be normal?"


    Mother Carolyn is in jail, along with her husband, awaiting trial for the murder of her child. The autopsy revealed that Rebecca was on extremely large meds doses. The prosecution is claiming that an overdose of clonidine, a hypertension agent not commonly used for bipolar, was enough to cause her death.


    "Sixty Minutes" slipped in a quickie interview with a token expert, Joseph Biederman MD of Harvard. Dr Biederman is a pioneer in recognizing that kids may have bipolar, and in treating the illness. I had occasion to talk to Dr Biederman and hear him speak at an NIMH conference soon after the Rebecca Riley story broke in the New York Times, and later at the American Psychiatric Association annual meeting.


    The Dr Biederman I heard and the Dr Biederman that "Sixty Minutes" chose to air was not the same Dr Biederman. A 15-year-old kid learning Apple's Garage Band software could have done a better editing job than "Sixty Minutes."

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    Dr Biederman made it very clear to me that it is very easy to distinguish bipolar behavior from high-spirited child behavior, and that you don't just do nothing for these kids.


    "Sixty Minutes" chose to air a badly-spliced Dr Biederman between its own gloss of how these meds were not approved for treating bipolar kids and how there is no consensus on the child bipolar diagnosis.


    Reality check number one: The FDA regulates the SALE of medicine, not the PRACTICE of medicine. FDA approval results from the application of the company making the drug. The company's application is based on marketing decisions, not medical decisions. Off-label prescribing is common and is often best medical practice.


    Reality check number two: Yes, there is no consensus on the child bipolar diagnosis. Equally, the best bipolar experts in the world are highly critical of the DSM criteria for adult bipolar. Where there is consensus is that there is a clearly observable phenomenon, both in kids and in adults.


    Reality check number three: Experts apply a far stricter criteria to child bipolar than adult bipolar. Sixty Minutes recklessly and erroneously reported the opposite. In general, psychiatrists look for adult features PLUS a range of frightening behaviors. But psychiatrists do make allowances for the extreme rapid-cycling that kids evidence (if one went by the DSM time minimum of seven days in a manic episode, then no kid would ever receive the bipolar diagnosis).


    After spending most of its segment on Rebecca Riley, "Sixty Minutes" turned to another kid. At last, some balance, I thought. Not to be. "Sixty Minutes" produced a clinician who claimed the kid had been misdiagnosed with bipolar, but was really an ADHD kid with sleep difficulties.


    This was an extreme irony. For years, bipolar kids had been misdiagnosed as having ADHD, been given the wrong meds, and had gotten worse.


    Time was running out. "Sixty Minutes" gave the quick once-over to a mom who did have a bipolar child, but only as a segue to how dangerous bipolar meds are.


    Yes, the same profession that tends to overmedicate adults is bound to overmedicate kids. This is a real problem, especially for kids, who are extremely sensitive to side effects such as weight gain and cognitive dulling. The meds are imperfect at best, and pose a real danger when an incompetent psychiatrist is combined with a trusting but uneducated parent. A thoughtful news story could have brought this out without frightening away concerned parents.


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    "Sixty Minutes" had all of one minute left to get it right. But Katie Couric was back with Rebecca Riley's mother, Carolyn, interviewing her in prison. Ms Couric, obviously reading from a script handed to her by her producers at "Sixty Minutes," asked Carolyn if she thought her daughter was "really bipolar."


    Ms Couric's tone of voice and body language indicated she was pushing for a "No" answer. She got what she wanted:


    "Probably not," Carolyn answered.


    "What do you think was wrong with her, now?" Couric asked.

    "I don't know," Carolyn relpied. "Maybe she was just hyper for her age."


    Cut to dark screen. End of segment. Beginning of Dark Ages. Has the news media lost its humanity, together with its power of reason?


Published On: October 01, 2007