Last week, I posted about child bipolar. The media and indeed some of the psychiatric literature misreports child bipolar as a “controversial” diagnosis, as if the condition does not exist or as if the diagnosis is a Pharma marketing ploy. My answer to this is talk to any mother who has had to deal with her ten-year-old jumping out of a moving car, then get back to me.
However one feels about the issue, it pays to keep in mind that the push for recognition that even young children can experience bipolar came from the parents of these children. When it came to their own kids, concerned mothers and fathers were way out in front of psychiatry.
The other thing to keep in mind is that we are not talking about a case of bipolar vs normal. These parents report behavior far from normal. The real question is “What is the cause of the behavior?” Bipolar or something else? ADHD? Conduct disorder? Environmental toxins?
The controversy over bipolar vs normal comes later in the life cycle, during teenhood, when, overnight, a not-yet-fully-developed brain has to deal with the complexities of life changes, socially adapting, and runaway hormones. Suddenly, crazy is the new normal. But is it bipolar? Probably not.
But life is never that simple. Teenhood, of course, is the very time bipolar chooses to rear its ugly head. The issue has to due with the field of “development.” The topic first came to my attention in 2009 at an international schizophrenia conference. There I was, first thing in the morning, at a table, sipping my neuro-cognitive starter. A woman sat down across from me with her neuro-cognitive starter.
We got talking. The woman - Beatrix Luna of the University of Pittsburgh - explained to me that adolescence involves major risk of mental illness. This is when the brain changes gears. But what if something goes wrong in the transition? As she told her colleagues in a session on brain development later that morning: Might this underlie the pathology of mental illness?
To vastly oversimplify: During adolescence, the brain undergoes "synaptic pruning," along with “axonal myelination." As the brain transitions to adulthood, its function “normalizes,” with less input from the primitive limbic system and brain stem. It takes until about age 25 before the adult brain is fully in place. But again: What if something goes wrong?
Dr Luna was talking in the context of schizophrenia, which also chooses to rear its ugly head around the same time as bipolar. This is a field obviously requiring a lot more study, but that shouldn’t stop us from asking our own questions.
There is another complicating issue. Researchers have long recognized that illnesses such as schizophrenia and bipolar do not simply happen overnight, that “prodromal” symptoms tend to make their appearance years in advance. Think of your own life, and then wind back the clock. We all have different stories, but what we share in common is the realization that we somehow knew that something wasn’t right with us, way before others recognized it.
We may have come across as thoroughly normal. Perhaps better than normal, enviable, even - smart, sociable, and all the rest. Or maybe (if you were more like me) a bit weird and eccentric. Somehow, even as we were falling apart on the inside, we managed (more or less) to hold it together on the outside. That is, until we were no longer able to hold it together.
Author Terri Cheney in “The Dark Side of Innocence” writes of attempting suicide at age seven. She devised a cunning plan that involved stealing her mother’s pills and swallowing them. She woke up. Her mother couldn’t find her pills. No one suspected a thing. Terri goes on to describe growing up leading a sort of double life - vulnerable on the inside, the envy of her peers on the outside. Somehow, she managed to fool everybody.
Until, of course, she wasn’t able to fool anybody. That story is told in her first book, “Manic: A Memoir.”
“Things fall apart,” wrote Yeats. “The centre cannot hold.” Significantly, this was the basis of the title in Elyn Saks’ memoir of madness. Sylvia Plath also quoted the line in her journals. We’ve all been there, trying to hold it together. Alas, one day it happens - the center cannot hold. Innocence destroyed.
Published On: March 10, 2013
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