Bipolar Disorder

Jupiter’s Moons and Childhood Bipolar Disorder

The complexity of observation

Posted Jul 07, 2016

public domain NASA, from Wikimedia Commons
Source: public domain NASA, from Wikimedia Commons

Astronomy of the 1600s and contemporary psychiatry share a similar position on the trajectory of scientific development; astronomy in the 1600s was a young science, as psychiatry is today.   Studying the former may shed light on some of the conundrums and shortcomings of contemporary psychiatry’s efforts to become more scientific.  Lawrence Lipking, in What Galileo Saw, places the discoveries of the best known early astronomers of the 1600s in the context of their beliefs in magic, alchemy, and religion.  These beliefs existed alongside the astronomers’ interest in understanding a wide range of phenomena in an apparently material universe. 

The book describes Galileo’s meeting with several leading astronomers, at which Galileo planned to show them the moons of Jupiter.  Galileo was the first to discover moons around Jupiter.  He found them with a telescope he had invented and built himself. 

The meeting was held on the nights of April 24th and April 25th, 1610.  Galileo had published his results a month earlier.  Several invitees refused to attend.  They claimed they knew the appearance of the universe; it had already been well described in the Bible, and there was no point in efforts to go beyond that source of unchallengeable knowledge.  Among the handful who attended, many were unable to see the moons that were plainly visible to Galileo.  Some had trouble using the small telescope and could not focus their eyes to see the moon through the unfamiliar instrument.   Lipking speculates that some could not see the moons because their cosmological beliefs did not prepare them to see moons around Jupiter; their beliefs may have blinded their perception of the moons.  Kepler, a renowned astronomer, who was there with Galileo that night, was unsure whether the discovery of the moons might invalidate his own astronomical calculations. He reserved comment until he reviewed his own data.  After he rechecked his calculations and found that the presence of the moons did not contradict his own work, he became an enthusiastic supporter of Galileo’s observations.

Contemporary psychiatry has a different problem about observing phenomena from that of astronomers of the early 1600s.  Instead of an inability to see obvious phenomena, contemporary psychiatrists have a tendency to see phenomena that are not there.

For example, the number of psychiatric diagnoses defined in DSM I (1952) was 106, and the number defined in DSM-IV (1994) was 365 (1994).  It seems reasonable to speculate that among this 300% increase in diagnoses there may have been  several that did not actually exist.  For example, multiple personality disorder, a favorite diagnosis of the 1990’s is rarely made today and seems to have little basis as a psychiatric disorder.

This inclination to study entities that do not exist is evident in the diagnosis of bipolar disorder in children 12 years and younger.

Bipolar disorder in childhood first became a topic of public discussion with the launch of the book, The Bipolar Child, by Papolos and Papalos, in 1999.  The book’s publication was accompanied by the author appearing on three highly watched TV shows: The Oprah Winfrey Show, 20/20, and the CBS Early Show.  The book is largely devoid of scientific content, but discusses an array of symptoms unrelated to the diagnosis of bipolar disorder in DSM. The book is mainly concerned with anger in children.  It was among the most successful books ever written in the popular press in psychology.  It created a demand among parents for their children to receive this diagnosis from mental health professionals and to have their children treated for it.

The book received important indirect support from NIMH, which became interested in the diagnosis.  NIMH funded studies of the disorder for which university medical centers eagerly competed.  This led to an avalanche of publications in professional journals endorsing the syndrome.  The prestigious studies served to further solidify professionals’ belief in the diagnosis.  There was considerable divergence between academic centers about the appearance of the disorder, but this did not dampen the belief in the disorder or enthusiasm for studying it with funds from NIMH.  University medical schools gave professorships in the study of child bipolar disorder.  The diagnosis of bipolar disorder in childhood increased forty-fold from 1994-1995 to 2002-2003.   This was a diagnosis that was believed to be nonexistent or rare before this time.  The FDA began to solicit pharmaceutical studies for the treatment of the disorder.  Most of the children with bipolar disorder seemed to have ADHD as well.  A widely believed injunction against the use of stimulant medication in bipolar disorder led to withholding this effective treatment from many children who desperately needed it.  Other children were given medications used to treat bipolar disorder in adults, with little empirical evidence to support their use. 

In the development of DSM-5, the over-diagnosis of bipolar disorder in children aged 12 and younger was recognized, and efforts were made to address it.  First, against the wishes of the proponents of the disorder, DSM-5 refused to create a separate diagnostic category of bipolar disorder for children aged 12 and under.  Instead, DSM-5 retained its usual diagnostic standard of identical criteria for children and adults; adult criteria would need to be met for children to receive the diagnosis.  Second a new diagnosis, disruptive mood dysregulation disorder (DMDD) was created to decrease the incorrect diagnosis of bipolar disorder in children.  The DMDD diagnostic category was created for chronically angry children who have severe temper tantrums. These children were often misdiagnosed as having bipolar disorder.

1.Lipking, L. What Galileo Saw, Cornell University Press, Ithica and London, 2014.

2. Papolos, D. and Papolos, J. The Bipolar Child 3rd edition  Broadway Books, New York 2006.

Copyright: Stuart L. Kaplan, M.D., 2016. 

Stuart L. Kaplan, M.D., is the author of Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis.  Available at Amazon.com.