Monday, July 17, 2006

Medicating Kids

A column in The Albuquerque Tribune tackles the thorny question of the rapidly rising number of children being diagnosed with bipolar disorder. While some might argue that the columnist is being overly cynical when he credits the rise to profiteering corporations and lazy parents, I think he's right.

Frankly, unless my child was having active hallucinations, delusions or suicidal impulses, I would be incredibly hesitant to put him/her on a psychiatric medication. I suppose I would take what I've labelled the Dr. Phil approach to the problem. That kid would have to earn that medication. I would try every other available treatment, from traditional counseling to massage therapy, before attempting to mainpulate my kid's brain chemistry in order to correct a troubling behavior. And the definition of a "troubling behavior" is the crux of the issue when medicating children.

When does a child's temper tantrum cross the line from normal to pathological? That's a question I'm very happy that I don't have to answer as a professional because it would very difficult to tell a parent that actually, their child isn't mentally ill, he's just a brat.

On the flip side, I think it would be horrible to have a child that isn't clearly well or clearly sick. Personally, I don't think people should medicate children unless they are clearly sick, but I have a lot of compassion for the borderline kids because mental illnesses do come on a spectrum of severity and there are bound to be those who fall into the nebulous zone of might. It might be beneficial and it might be detrimental. Do you gamble?


Thursday, July 13, 2006

The Mentally Ill Soldier

Barbara Boxer and several other lawmakers have been pushing the military to revise the way mental health and deployment is dealt with so that soldiers are not sent back to combat with PTSD or other serious psychological problems. Of course, any military hopeful diagnosed with bipolar disorder knows that bipolars aren't allowed...kind of like openly gay people.

This got me thinking though. Bipolar disorder often presents in the late teens and early 20s and isn't properly diagnosed as such until three to five years after initial contact with a psychiatrist. The disorder itself, like schizophrenia, is often triggered by some kind of stressful life event--death of a family member, a break up or divorce, moving etc. It's very possible that the trauma of war and being so far from home is enough to stoke the embers of bipolar disorder into a full blown fire.

I wonder if being bipolar could be an asset to a soldier--not that I would advocate sending bipolar people into combat. But as a thought experiment, it's a provocative thought. If I was a certain type of manic, I think I could make a better soldier than a psychologically "normal" soldier. Think about it. I would to sleep or eat as often as my "normal" peers. My thoughts would be endlessly swirling in my mind, meaning that I would be thinking through strategic problems just to have something to think about. I would understand that people die, but my inflated ego would dampen my own fears of mortality. There's a lot to be said for that.

Of course, trying to manipulate a certain strain of mania from the masses is pretty much impossible, which leads me back to the whole reason I thought to post about this. Other diseases have known causes. AIDS is caused by a retrovirus, for example. Because scientists know that, they could develop a test for it and viola, we know who has AIDS and who doesn't with a fairly decent accuracy. The same can't be said for any mental illness. I could send my husband to a psychiatrist with a fictional account of his life and he could walk out diagnosed with depression or ADD or bipolar disorder or whatever. I'm increasingly understanding the value of being able to say with some finality that a particular person has the affliction they claim to have.

Now, bipolar is an interesting case because you can look a scan of someone's brain and see how the illness has changed their brain...or how their abnormal brain causes the illness. Chicken or egg. But how many bipolar people have had their brains scanned? I have, but I don't think I'm in the majority.

Why is it important to have proof like that? Because there are dozens of other medical conditions that can mimic the symptoms of bipolar disorder and if those are treatable and curable, then why the hell would anyone condemn a person to a life of taking psychoactive drugs with their charming array of side effects? We need a test.

And if we had tests for mental illnesses, it would be much easier for mentally unstable soldiers to stay home because they could prove it. Tests aren't so important to people with extreme manifestions of these illnesses because few people are going to question the fact that those people are ill. Tests are invaluable to people in the middle of the spectrum, people who have symptoms that are disruptive but maybe not so bad.

Psychiatry, like all medicine, is supposed to be a science. It takes an uncanny amount of trust to allow physicians to manipulate brain chemistry without knowing if they're even manipulating the proper thing. It's the best we've got, but man, it kind of sucks.