Friday, August 05, 2011

Retriever Blog: Fad Diagnoses in Kiddie Psychiatry?

In response to Joy Bliss' post (Fad diagnosis in Psychiatry: Bipolar Disorder in children) on Maggie's Farm,  Retriever wrote about her experience with a child with an early and severe mental illness, and short-sighted attempts to reduce access to needed intensive mental health treatment for children.

I do think that diagnosing behavior problems in kids has been overextended, due more to loose interpretation of current diagnostic criteria rather than to overbroad criteria. But let's not throw the baby out with the bath water.

(Speaking of water, taking a break here from vacation to post an image from Southwest Harbor, Maine.)


Sarebear said...

Ooh, now I can picture some of the settings in some mysteries I've been reading; the protagonist just went to Southwest Harbor, and the series is set on a Maine island.

Gray Whale Inn is the mystery series.

Anyway, it's so serendipitous that you'd post a picture that shows exactly the scenes I've been reading, lol!

Wish I was there, I miss the east coast. Went to Cape Cod once as a kid. I mean it's gorgeous out here in UT but the east has it's own kind of gorgeousness, and just a different feel in the air . . .

dang, I'm waxing nostalgic.

Retriever said...

Thanks for the link.

Have often wondered about the degree to which these diagnoses are more prevalent now because of the attempt to get inaurance to reimburse for genuinely needed treatment (doctors and social workers will often be quite blunt with families about how one diagnosis will get approval from the bureaucrats, another won't).

This obviously muddies diagnostic categories. Nobody is committing fraud, because diagnosis is such an inexact science. Many kids qualify for several. And, for example, to expect a child who MAY have bipolar disorder (or who may grow up to have bipolar disorder) to have the same symptoms as an adult is a little silly. Kids with leukemia present differently and respond to treatment differently than adults with leukemia yet nobody says the kids don't have leukemia because of the differences.

Another issue is the one of stigma. Because of Hollywood and the internet, people hear about supposedly bipolar celebrities who are rich and successful anyway and so parents might have an unrealistic idea of the terrible toll the disorder can take on people. They might think that "everyone" is bipolar, so think that it's okay to say that that's what their kid has when the kid actually has something like Oppositional Defiant Disorder (which everyone knows is a BAD thing) or a personality disorder, which is far more stigmatized and unlikely to be adequately reimbursed by insurance.

Parents are not usually operators or scammers, they are doing the best they can. The commenters over at Bliss' post, however, display the typical hostility of those who suspect moochers of being after their tax dollars, or else just bad parents.

I should add that most parents of severely mentally ill children have had to endure repeated periods of suspicion, blaming and assumptions by other parents, and some clinicians, that their child's difficulties stem from abuse or neglect. This adds insult to injury. Not only are you socially isolated while trying desperately to take care of a sick child, give a normal life to your other, healthy children and hold onto the job that provides the health insurance, but you have social workers looking cross eyed at you. I never took it personally as I had worked before marriage for a child welfare agency and we had a clear conscience, and a loving family. But even then, a biologic, clear diagnosis is something of a relief as no one can blame parents for it.

Parents of severely mentally ill children are in mourning for the life they had hoped their child would have, for the family life they had hoped they would all have. To this had shame (faced with community prejudice and blaming), guilt (we were all raised that it's ALWAYS the parents' fault) and desperate bargaining with God/the Fates...there is an element of "If I take on this horrible label for my child, give them these evil medicines, they will be purified and cured, and made whole" Witchdoctors know this natural human tendency very well.

rob lindeman said...

F bombs and invective hurled at political parties and doctors don't make for very effective debate. Even words of truth, delivered in anger, seldom reach their mark.

All the swear words and invective do not answer the fundamental difficulty we all have with mental illness, that Dr. Outlined succinctly in her post. As long as we lack objective, measurable, reproducible diagnostic tools, differentiation between normal and disease will remain impossible. Go ahead, Retriever, yell all you want. When you're done, we still have this problem.

Retriever said...

Rob, focussing on the anger behind a rant (ie: criticising someone for swearing) reminds me of the way people used to discredit minorities and women seeking equal rights by saying that they were "too angry". It's a distracting technique, discrediting a point of view because of the righteous indignation of the person holding forth.

In an ideal world none of us would swear. Ever. But we're only human. And when parents read revoltingly prejudiced comments (as beneath the post of Bliss') about mentally ill childre, it rather riles them...

Jane said...

...I read the Newsweek article where the shrink talks about treating an 11 year old "bipolar" girl with ADHD medicine. She became a whole new person and totally well adjusted. I just hope the bipolar diagnosis doesn't hold any of the kids back from treatment that might help them if they actually have something else. I know you could probably do that with a lot of disorders (misdiagnose and mistreat), but these two look like they have a lot of overlap.