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