The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder

In 1985, Jacob Needleman wrote a book called The Way of the Physician (1), in which he described a sentiment disturbing in that it echoes complaints from both patients and physicians:

The result of the first collaboration of Demitri and Janice Papolos was a patient-friendly book called Overcoming Depression (2), which in its third edition has been a steady companion for all the families who have seen me in my practice. The day after Demitri Papolos appeared on the television program 20/20, a mother who removed her child from my care 4 years earlier because I had diagnosed him as having bipolar affective disorder called to ask me to take her child back as a patient. Since then, she has become an active advocate in our area for the aggressive diagnosis of bipolar affective disorder in children and adolescents. Reading the Papoloses’ The Bipolar Child, more than anything I ever said, convinced this woman of the necessity of having her child placed in a residential setting despite her own guilt feelings and the vicious attacks of other relatives of the child.

The Papoloses state that participants in a web site on children with bipolar disorder, started by the mother of a boy with the disorder, have acted as an interactive cadre of demanding but loving editors who helped actively shape this book. Parents of my patients with bipolar disorder who have read the book returned to treatment with the whole family and have become active change agents at home, in school, and in our local government. Reading the book fuels an enlightened advocacy for the appropriate treatment modalities described by the authors in clear, simple, and concise terms.

To explore such emotionally charged topics for families of children with bipolar disorder is a formidable task, but the Papoloses are successful. I haven’t had a single parent express resentment or negative criticisms of the book. None felt that the concepts or terminologies were too technical, and none complained about the price of the book.

The Bipolar Child is divided into four sections: Diagnosis and Treatment, Inside the Brain and Mind, Living and Coping With Bipolar Disorder, and Life Goes On. In the first section, the authors accurately explain how the effects of the extreme rigidity in diagnostic criteria for this disorder developed by the late E. James Anthony and his group in the 1960s and 1970s made it almost impossible to treat all but the worst cases in a child psychiatric practice. Having read the case of a 2-year-old girl treated by Annalisa Annell in Scandinavia in the 1960s, I diagnosed and successfully treated one such 2-year-old in 1980.

The Papoloses’ handling of the touchy issue of comorbid disorders is especially skillful, particularly in the case of comorbid attention deficit hyperactivity disorder (ADHD). Tackling the question of antidepressants and central nervous system stimulants head on, the authors hit a very raw nerve with the parents I see, especially in those cases where family physicians or nurse practitioners prescribed these drugs to children without taking a thorough history, particularly in the area of the psychiatric family history. The Papoloses caution parents about the iatrogenic induction or aggravation of hypomanic and behavior disorders of these children: a scenario we in child psychiatry are all too familiar with once such families finally find their way to us. In one of my families I found that the treatment-resistant father had symptoms of ADHD, depression, and a reading disability. He sought treatment after he and his wife read this book.

I found the concepts of psychopharmacology and neurochemistry easier to understand in this book than they have been in any continuing medical course, except perhaps the one given by Stephen Stahl in Chicago last year (3). The Papoloses include suggestions for treatment with omega-3 fatty acids and light therapy.

The book’s discussion of the 21 most common, 19 very common, and four common associated behaviors and complaints resonated with all of my patients and their parents because they recognized these behaviors and complaints in themselves and in their families. Readers who were skeptical and distrustful of psychiatry felt free of shame and fear of ostracism and moral judgment from their peers.

This book’s third section is as gritty, hard-hitting, challenging, practical, and self-empowering material as I have read in any book intellectually accessible to my patients and their families. The Papoloses navigate the difficult course of dealing with the impact of the illness on the patient and the family, finding the right professional and institution, dealing with schools, and negotiating with insurance companies.

The Papoloses remove the often crippling attitude of victimhood and assignment of blame that so often mires our patients and their families in hopelessness. They convincingly and passionately persuade them instead to realize that everyone is responsible but no one is to blame. I hope that all physicians and professionals in the helping professions out there openly welcome the Papoloses into their worlds.