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this book. It shows a child’s hand grabbing a massive number of pills. [Scroll down to read some of the book.]

Your Child Does Not Have Bipolar Disorder
is a richly deserved attack on one of Harvard University’s most prominent professors, Joseph Biederman, a man whose financially self-interested insistence on this serious diagnosis continues to damage and stigmatize millions of young children.

The book’s author, Stuart Kaplan, a professor at Penn State, also has a blog on which he worries, in a day-to-day way, about the psychiatric profession maintaining Buy-Bipolar Biederman’s regime. He notes that although the diagnosis is gradually (thanks to books like Kaplan’s, and to Biederman’s having been sanctioned for taking and not disclosing drug money) being discredited, the editors of the latest, in-progress DSMV are still saying things like this:

… ‘[C]lassic’ adult [bipolar disorder] clearly does present in pre-pubertal children as well as in adolescents, although it may be rare in the younger age group. Unambiguous agreement about this fact weighed heavily in the Work Group’s deliberations.

Kaplan goes to town on this:

The use of the wording “unambiguous agreement about this fact” is a coercive rhetorical device that has held sway for more than 15 years in the pediatric bipolar scientific literature. Instead of providing evidence, the Work Group attempts to persuade the reader that everyone who is smart and important knows this to be true. In truth the assertion is unfounded and has no place in sophisticated scientific discussions of bipolar disorder in children. The clause “although it may be rare in the younger age group” suggests some hesitation on the part of the Work Group in endorsing the existence of Bipolar Disorder in pre-pubertal children.

That the committee accepted as fact that bipolar disorder exists in children raises the issue of the use of the word fact in psychiatry as contrasted with its use in other sciences and in everyday conversation. The use of word “fact” in scientific papers in psychiatry is highly unusual. The use of the word in this context by the DSM-V Work Group is jarring to regular readers of the scholarly literature in psychiatry. In this scientific literature, papers end with conclusions preceded by discussions that are expected to point out the limitations of the scientific work. Conclusions are usually modest, tentative and limited. The word fact is almost never used.

Are there “facts” in psychiatry comparable to the physical constant of the speed of light in physics, the periodic table in chemistry, the function of the adrenal gland in biology, or the boiling point of water on the earth at sea level in everyday life? There may be some (e.g., need for an adequate environment for infants and children for psychological growth and development) but most so called facts in psychiatry are brief stand-ins or proxies for many inferences and theories that shift and change abruptly. For example, the diagnosis of bipolar disorder in adults is based to some degree on the diagnosis of Manic Depressive Insanity first developed by Kraepelin. The veracity of his observations and theories about psychosis are part of the brew of the current diagnosis of Bipolar Disorder. The diagnosis is based to limited degree on Kraepelin’s theories and a large number of other hypotheses many of which are disputable. Fact as the acceptance of some immutable truth does not enter into the discussion.

When the DSM-V Work Group refers to the unambiguous fact that the disorder exists in prepubertal children, does the Work Group have any specific age range in mind? Preschoolers? Children ages 10 years to 12 years? Children ages 6 years to 12 years? Each of these age groups has been the subject of controversy related to bipolar disorder in children, but they are lumped together without any discrimination between them. Similarly, the use of the word “rare” by the DSM-V Work Group remains inexplicably undefined. The expression “rare” has a specific meaning in medicine, referring to a prevalence of 1 or less cases per 1500. Is this what the DSM-V Work Group means? There is a startling lack of precision in the discussion of the existence of pediatric bipolar disorder in childhood by the DSM- V Work Group. Many people, myself included, believe it is closer to the truth to assume, until proven otherwise, that this prepubertal “disorder” does not exist at all.

The misdiagnosis monster lives: the stake must still be driven in to the heart of the beast.

Beast? Why the strong language?

Because the diagnosis is doing terrible things to children; and because the only people benefiting seem to be the people who sell all those pills under the child’s hand on the book’s cover.

The bipolar monster was loosed because American university professors, in cooperation with drug companies, created it. Indeed the problem that confronts us now, as Kaplan says, is how to kill it.

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7 Responses to “Look at the cover of …”

  1. Bernard Carroll Says:

    Leaving aside his tendentious style, I think your source Stuart Kaplan is over the top here.

    His call for facts in psychiatry that parallel the laws of physical science is naïve. There is no determinism in biology comparable to the physical and chemical laws of nature. That is true of all of biology and thus of medicine and thus of psychiatry as well. Even his one biological example about the adrenal gland is off target – we are still learning the details of how the adrenal gland is regulated. Biology, medicine and psychiatry are areas of deep complexity.

    This, in fact, is the reason for maintaining skepticism and for avoiding “unambiguous agreement” about a question like childhood bipolar disorder. Psychiatry should have learned the perils of unambiguous agreement in the psychodynamic era. The present debate rages because conjecture became dogma, to the detriment of the children. How that happened is another story, which you have covered very well on this blog, UD.

  2. dmf Says:

    almost none of the children at issue have any obvious symptoms of mania or depression (psychiatry in its current primitive state is in the business of symptom relief) and since we no little to nothing about (let alone have a test for) the mechanics/causality of such disorders there was no serious scientific basis for such a diagnosis to ever be made. The physiology involved is indeed complex but so is particle physics and molecular chemistry and this does not rule out the need for actual testable understandings of causality/tx.

  3. dmf Says:

    ps this diagnose for children arose for the same reason that many now want to reclassify “personality” disorders as bipolar b/c there is a medication to be sold for it.

  4. Bernard Carroll Says:

    @dmf: As I said, conjecture became dogma, to the detriment of the children. You overstate, however, when you say “almost none of the children at issue have any obvious symptoms of mania or depression…” They had lots of symptoms, and most symptoms are nonspecific. It’s that the symptoms were reframed to fit the desired narrative of childhood bipolar disorder, principally by an indulgent inclusion of the nonspecific feature of irritability as an alternative to the elated, grandiose mood of classical bipolar disorder. This reframing conjecture was never compelling but it was worth testing, if only for us to reject it. The problem is it was not properly tested, yet it developed runaway momentum. Were the pharmaceutical corporations stirring the pot? You bet.

    1boringoldman has further useful commentary here:

  5. dmf Says:

    never compelling but worth testing? on whose children? what you call indulgent I call fraudulent, unethical, and dangerous. let’s not kid ourselves about how this became so widespread I was subjected to many of the conferences/sales-pitches and the corporate sponsorship wasn’t subtle.

  6. Bernard Carroll Says:

    Let’s not conflate the scientific conjecture with the experimercials that were driven by Pharma and the KOLs. The scientific conjecture about the nosology of juvenile bipolar disorder was worth testing, and that could comprise studies of family history and of adult outcome, for instance, as well as treatment studies, which themselves did not need to be limited to antipsychotic drugs. The story here is that Pharma hijacked the academic research agenda, just as they did in adult bipolar disorder. At the same time, the use of antipsychotic drugs for supposed juvenile bipolar disorder was already showing up in off-label use. So it needs to be tested for the same reason that any unproven treatment is worth testing. A formal test with a negative result is the most effective way to extinguish such inappropriate use of medications. But when the tests that are run are really experimercials, or worse, then everybody is misled and the children are not well served.

  7. University Diaries » Above all, this blog has tried to chronicle… Says:

    [...] presidents who presided over obscene corporate bonuses; professors with outrageous corporate conflicts of interest, and so [...]

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