Bipolar Disorder in Adolescents–The good doctor was WRONG

 I put the following up because of how many important messages it sends to me, to patients and to parents . . .

I was a patient of yours 5-6 years ago when I was between the ages of 14-16. I was quickly diagnosed with bipolar disorder and prescribed pills (first depakote then, after learning the side effects, zyprexa). Every session we had never seemed to last long and consisted mainly of you and my mother discussing my acting out. Any time I consisntently acted out it was because I was “spitting out my pills” (even if I wasn’t) which led me to realize something was seriously wrong. I felt as if you never listened to me, the patient taking the pills. When I was 17 I researched the disorder and found how difficult it is to diagnose in teens. Much like ADD, ADHD, and depression, bipolar disorder has many of the same “symptoms” of growing up and being a teenager. I stopped taking medication and going to therapy and am now a happy, functioning, well-adjusted adult with a secure job and homelife. I wanted to give you this update/feedback to help you to not to make the same mistake with other kids. By undermining my feelings you ended up advocating my mothers delusional thoughts about me and my life. Not to sound rude, but you probably have less experience in teens with BD than you think. Not to say that there aren’t kids out there with serious mental health issues but you need to better consider the idea that maybe they are just rebelious teenagers. Pills should be the last resort, especially for minors who don’t get much say in what happens. Please,  don’t do to others what you did to me. Listen, listen, listen…

I am humbled . . .

But also happy for you. Ultimately, the point of what I do is to get people to where you are.  Hopefully, they get there in part because of what I do . . . not despite what I do.  For however I failed you, I apologize. 

This psychiatry thing is very difficult and not without it’s pitfalls.  Psychiatrically managing a patient’s mood and behaviors is very difficult since, in reality, there is such a wide range of “normal” kid behaviors.  Some of which can be very difficult at times.  If you add onto that the “filter” that occurs when parents are used for information, the possibility that the parents are dysfunctional and perhaps ill themselves, and then the severe time constraints that exist within the current mental health system . . .

It is, perhaps, a wonder that I ever get it right.

Here is what I have learned from your letter.  I need to listen differently.  Clearly, you had something to say that I did not hear.  How, can I get that information??? The “managed care system” give patients very little time with psychiatry . . . and it is likely to get worse before it ever gets better . . . if it ever IS going to get better.  I already know that most of the kids that I work with trust me marginally, yet I ask them to condense their most intimate emotional thoughts down to a 10-15 minute visit that typically occurs in the presence of their parent/guardian.   I wonder about ways that I might be able to make them more comfortable and make it more likely that I get the information that I need.  Could the therapists that I work with get the information better than they do now???  Would more time with me periodically be helpful???  Despite the hurried pace of the day, we therapist/psychiatric types need to slow down enough to read between the lines and be responsive to our adolescent patients.

A lot of questions.  Good questions. Good questions that need to be answered. 

I pledge to all of you that I will make greater effort to listen better.

Here is what I hope others learn from your letter: 

Kids–If you have something to say to your psychiatrist or therapist you HAVE TO SAY IT.  Ask for time alone. Write a letter.  Be specific.  If you think that we are missing the point . . . getting it wrong . . . need to know something . . . MAKE SURE WE KNOW.  If I didn’t say it to you I am sorry, but I frequently tell kids that I WANT them to tell me if I am missing something.  If things at home are terrible.  If their med’s are not working.    If the side effects are too much.  I really do want to hear that.  My guess is that most of my colleagues want to hear that as well.

Parents–Don’t just medicate your kids behavior away.  Biology is a component of many kids with behavior issues, but you must also change your approach to your kid.  Treat them differently, give them different expereinces.  Adjust the consequenses.  Make sure you spend time with your child and that you make every effort to hear them and not to judge them.  Life is more difficult these days and the last thing they need is someone yelling at them and judging them.  Talk to them, spend time with them, praise them for what they do.  Get them help when they need it and allow them to be open and honest with the therapist.

Lastly, to the author of the above letter:  The mental health system is heavily flawed . . . in part because of money (which is at the root of insurance issues and time constraints, isn’t it??) and part because it is, at it’s core, a relationship and relationships are often rockey and fraught with potential for miscommunication.  Despite the difficulties that you had, don’t shy away from seeking mental health treatment if you or a family member needs it.  I would assume that your experience will lead you to be very selective and critical of the therapist/doctor that you choose for yourself or your family member.  That is good . . . I encourage that from everyone.

–Dan Hartman, MD

2 comments to Bipolar Disorder in Adolescents–The good doctor was WRONG

  • B

    What I needed (and I think most teens with “bipolar disorder” need) is to be told that they are NORMAL and that hobbies, school, and time will more than likely solve their problems. Parents NEED to be told this too. Every time I was taken out of class and thrown into the hospital for forced-fed medication and 4-point restraints was another few days further from a normal up-bringing. Had someone taken a step back (from the conflicting statements of my family/me AND from the pressure of drug companies to prescribe prescribe, prescribe) they should have been able to see this. “Mental health professionals” are so quick to diagnose these days and even quicker to medicate. I feel like growing up has become a disorder in itself. Why not reccommend parenting classes, after-school activites? Those are probably more helpful than checking under your 14 year old’s tongue every morning for zoloft residue. It also re-enforces support systems, regularity, independence, trust, and stability. If non-medical suggestions don’t work after some months and only if a kid poses IMMEDIATE danger (and I don’t mean cutting themselves for attention) do I think pills and in-patient care should be considered. Yes, considered. There should probably be a set minimum amount of one-on-one therapy time completed before diagnosis and/or medication is issued. Maybe even a required second opinion. I understand when a kid comes in who is a potential threat (to themselves or others) that you cannot overlook that or deny the seriousness of their situation. However, you/your colleagues need to take the time to know the difference between when you are feeding those ideas and when you are treating them. Most unmanagable teens need to be told they are normal and just over-reacting. If we keep buying into (what I consider to be) a pharmacuetical scam teens will use their “disorders” as a crutch well into their own adulthood. See welfare abuse and unemployment problems for more information. (When I was 15 I was “too bipolar to go to class.” Luckily I later got my act together). The mental health industry has seem to become an avenue for exploitation and greed in my personal experience. We all need to be more selective in how we go about treating ourselves and others. Especially for the minors who don’t seem to get much of a say.
    Thank you for your thoughtful response,

  • B–
    I’m glad you checked back in to get my response. You have opened an interesting can of worms here . . . Look at my main article for additional follow up. Interestingly, I think that there is, in some ways, less exploitation of kids/adults in the system. Used to be the threshold for inpatient was quite low. EVERYONE got thrown in the hospital and kept there for quite some time (not coincidentally until the insurance benefits were exhausted). Now, people barely get in the hospital and they are thrown out. The big push is to get people “better faster”. That requires medication since adapting your life is NOT a quick fix. I have found myself trying to NOT prescribe medication the first time I see someone and try to get them invested in working with one of my therapists to make some changes. People have a hard time buying into this. They want something to make things better. Not only that . . . they come armed with advertisements for medication. Abilify and Cymbalta are the two biggest offenders (they must have huge advertising budgets!!!). Thank you again for writing in and helping to keep me honest!
    –DH MD