“Bipolar Epidemic?”

About two years ago, within weeks of each other, two teenage children of dear friends of mine were diagnosed with bipolar disorder, one in the Midwest, the other on the East Coast. The diagnoses were given by psychiatrists whom their parents had consulted. I am not a physician, but I am deeply interested in diagnostic categories and have read extensively in the history of the subject. I knew both of the children in question very well. To be frank, the diagnosis of bipolar disorder amazed me. The label just didn’t seem to fit either child. I spoke to two psychiatrist friends of mine about these diagnoses and then, in conversation with the parents, I offered the only sensible advice I was in any position to give: Diagnosis is tricky. Make sure you get other medical opinions. Both children were seen by other doctors, and with those further consultations, the diagnosis was dropped. The two, now older adolescents, are doing fine. Neither one is taking any medicine. It seems that whatever they were suffering from at the time vanished with some growing up.

One child (I will call her P.), then fourteen years old, received her diagnosis after twenty minutes with the psychiatrist. He also wrote her a prescription for an anti-psychotic drug. If the circumstances had been slightly different, and P. had had parents more likely to fall under the spell of medical expertise, she might now be stamped with “bipolar” and frequenting the same psychiatrist to adjust her medication. Manic depression is a serious condition. The highs and lows of this mood disorder ravage lives, but identifying it is not like diagnosing, say, a urine infection or type 2 diabetes. Peeing into a cup or taking a blood test will get you nowhere.

Do we understand the physiology of bipolar disorder? The authors of a recent paper on neuroscience research into bipolar disorder write: “The heterogeneity of both imaging findings and neurotransmitter alterations has not yielded a single underlying hypothesis.” Although scientists hope to discover more, at the moment there is no consensus about the neurobiology of manic depression.
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