The first discussion at the inaugural annual meeting of the Neuroethics Society today, on the neuroethics of pediatric bipolar disorder, felt a little like déjà vu to me.
Fifteen to 20 years ago, nearly no child was labeled bipolar, said panelist Benedetto Vitiello of the National Institute of Mental Health; since then the number of diagnoses has jumped. “It’s really staggering … to go from practically nothing to nearly an epidemic,” said panelist Steven Hyman of Harvard. But the rise is not because children never acted out or had social problems until a decade ago; rather, we labeled it something else—or it wasn’t considered a problem.
“Because we are so focused on the pathological, we can miss the wide range of normal,” said panelist Josephine Johnston of the Hastings Center, who co-authored a briefing book on mental health in children and adolescents on the Center’s Web site. And diagnosing a child wrongly with bipolar disorder can stigmatize her as well as lead well-meaning parents to dose her with strong drugs that not only won’t fix the problem but could cause worse behavior—and serious physical complications.
This theme has come up twice during this past month here, at a forum held at the Dana Center on understanding childhood brain disorders and in “The meaning of psychological abnormality,” the current article in Cerebrum. To make her point, Johnston even read a quote from Cerebrum: “The contemporary American economy requires every child to complete high school with adequate language and mathematical skills, and preferably go on to receive a college degree, in order to obtain a job with some financial security. These were not requirements in the 18th century; Benjamin Franklin did not have the advantage of a high school education.”
Social constructions such as high achievement in education, which often means having the self-control to sit still for hours on end, are real in our lives, she said. “In seeking to change the child, we might also need to change the child’s context.”
Jerome Kagan (who also wrote the Cerebrum piece) spells out the argument against calling the jump in childhood disorder diagnoses an epidemic in the Webcast of the Dana Center forum, about 10 minutes into the piece.
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