by Martha Hellander

Peter Breggin, M.D., author of Toxic Psychiatry, Talking Back to Prozac, and Talking Back to Ritalin: What Doctors Aren't Telling You about Stimulants for Children, is a spokesperson for those who believe that brain disorders such as schizophrenia, bipolar disorder and ADHD were invented by the drug industry and the American Psychiatric Association to rake in profits at the expense of innocent people. I wish Breggin were right. It would be much easier to point the finger at drug companies and the APA than accept the reality of a genetic biological vulnerability in one's child that, when coupled with environmental "triggers" known and unknown, can cause a child's brain to malfunction and subject them to such fits of despair and suffering as to drive even five and six-year-olds to attempt suicide. How would Breggin explain the afflictions suffered by our ancestors with brain disorders before the advent of medication? A brief foray into the history of psychiatry suggests an existence unbearable to contemplate for long. Parents imagine with horror the fate of kids with bipolar disorder in times past (a Puritan law permitting children who struck their parents to be put to death hints at the suffering). Breggin's book "Talking Back to Ritalin: What Doctors Aren't Telling You about Stimulants for Children" caught my eye because of the numerous reports in the on-line community of children with (or at risk for) bipolar disorder who experience a severe worsening of symptoms when given stimulants. It is well known that most children with bipolar disorder usually have most or all of the symptoms of ADHD; this is a common misdiagnosis (or co-morbid condition). Unfortunately for parents who may read this book seeking answers as to why their children reacted badly to stimulants, Breggin does not even mention that such reactions in a child with "severe ADHD" symptoms are a red flag for bipolar disorder.

We must anticipate Breggin's arguments so that when friends and family become alarmed by his conspiracy theories and fearmongering and challenge our medical decisions, or a fearful spouse wields Breggin's books as a weapon against the other spouse's attempting to have a symptomatic child evaulated and treated, we can respond calmly and with scientific evidence. We can also direct them to the numerous stories of children stabilized and thriving with proper treatment, like those posted on The Balanced Mind Foundation's "Good News Stories" message board and reported in Demitri and Janice Papolos's book, "The Bipolar Child." If psychiatrists and the drug companies conspire to invent disorders, then what causes the children's symptoms? Not surprisingly, Breggin blames parents. These children are hurting, he says, and the remedy is just more parental attention and love. I doubt there is anyone reading this who did not do everything possible to help their child before turning to doctors and medical treatments. The irony is that, with access to good medical treatment at the first sign of definite symptoms in our children, rather than wasting years trying to treat a progressive brain disorder with hugs, sticker charts and positive talk, our children might have recovered more quickly and been spared whatever damage may have occurred from chronic cycling during the crucial developmental years of childhood.

The real danger of Peter Breggin is not in his ideas, which he is free to discuss and we are free to refute, but in how he frightens vulnerable parents away from treating their children with mood-stabilizing medication, the only treatment (besides ECT) effective in bipolar disorder in adults (studies in children are sorely needed). The best argument against Breggin's conspiracy theory is the growing body of evidence that bipolar disorder may be a progressive neurodegenerative disease involving abnormal cell death in several areas of the brain.

For example, researchers Melissa Del Bello, M.D., Stephen M. Strakowsi, M.D., and colleagues at the University of Cincinnati College of Medicine recently found significant atrophy of the cerebellum, a region of the brain that regulates mood, in subjects with chronic bipolar illness as compared with first-episode and normal controls, in the first MRI study comparing the cerebellar vermal area. And Husseini Manji, M.D. and colleagues recently used Magnetic Resonance Imaging (MRI) to confirm that adult subjects maintained on lithium over time suffered significantly less brain cell death--and even grew new neurons--than those not treated with lithium (similar results are emerging for valproate).

Such findings gradually illuminate the ravages of untreated bipolar illness in the brain. If replicated and extended to children, these findings may well justify very early and agressive intervention in children with emerging signs of the disorder, especially where there is a strong family history. Indeed, Manji ended a recent paper by asking whether all patients with bipolar illness should not be given low-dose lithium, regardless of whether it stabilizes their mood symptoms, because of its striking ability to prevent brain cell loss. This is powerful stuff for parents deciding whether to put a child on a mood stabilizer or attempt to battle this powerful disease, that may be eroding their child's brain, with hugs alone. Of course we parents look with hope to the promising research under way on alternatives or supplements to medication such as the use of lights to treat depression, stress-reduction, exercise, cognitive and interpersonal therapies, Omega3 fatty acids, and other alternative avenues of relief. We need any and all methods that may help our beloved children, including extra hugs, sticker charts, and positive talk, along with the daily meds. But let's dispense with conspiracy theories and battle the real enemy--bipolar disorder--with the weapons of research, science-based treatment, and public education.

Martha Hellander
The Balanced Mind Foundation Executive Director

Journal References: DelBello, Melissa, Stephen Strakowski, Molly Zimmerman, John Hawkins, and Kenji Sax. "MRI Analysis of the Cerebellum in Bipolar Disorder: A Pilot Study." Neuropsychopharmacology 1999; 2l(8), 63-68. Manji HK, Moore GJ, Chen G. "Clinical and preclinical evidence for the neurotrophic effects of mood stabilizers: implications for the pathophysiology and treatment of manic-depressive illness." Biol Psychiatry 2000 Oct 15;48(8):740-54.