SHYNESS author Christopher Lane interviews Philip Dawdy in Psychology Today "Side Effects"

"The bipolar child is a purely American phenomenon": An interview with Philip Dawdy

By Christopher Lane, Ph.D.
April7, 2009

Philip Dawdy, a prize-winning investigative journalist, has for several years written a powerful, well-researched, and well-regarded weblog, Furious Seasons, which focuses on American psychiatry, mental health, and the way we think about treatment options. Given his intensive work on the issues, I wanted to ask him several burning questions about ADHD, bipolar disorder, and other controversies in American psychiatry.

You've written extensively about the psychiatric diagnosis of teens and preschoolers. How do you account for the astonishing rise in the number of diagnoses we're seeing in these age groups, especially with regard to ADHD and bipolar disorder?

To me, you can lay all of this squarely at the feet of the pharma companies, which had a slew of newish drugs come online in the 80s and 90s and wanted them taken by as many humans as possible—consequences for the patients be damned—and a crew of child psychiatrists at Harvard/MGH who see deeply-flawed, ill-for-life children where other psychiatrists might see personality disorders and issues that will burn out over time. The pharma companies and the Harvard crew worked hand-in-hand to bring America a generation of ADHD kids and bipolar children, and their profound influence can be seen in the millions of children and teens who now carry lifetime diagnoses and take gobs of psychotropic drugs each day, often to their detriment.

That may sound extreme to some people, but it's worth noting that the rest of the world has not embraced these diagnostic and treatment paradigms—except Britain, where there was an initial embrace of ADHD and stimulants, but where there's now a significant backlash. Meanwhile, in France and Italy ADHD is rarely diagnosed and it's difficult to see where French and Italian culture have suffered as a result. As for bipolar disorder in kids (meaning pre-teens and younger), it's simply not an issue in the rest of the world. The bipolar child is a purely American phenomenon, as big a metaphor of our times as credit swaps, subprime loans, and government bailouts.

Why do you think so many more teenage and younger boys than girls are being diagnosed with ADHD, and what does that say about our culture, education system, parental expectations, and so on?

The data I'm familiar with pegs the boy-to-girl ADHD ratio at 3 to 1, which is pretty dramatic. I suspect that boys get pegged with the diagnosis more than girls do for two reasons: One, boys have always been far more energetic and physically exuberant than girls, a point going back through history, perhaps because they are developing their hunter-gatherer beings. And, two, the hyperactivity piece of ADHD is quite easy to spot and probably leads to greater pressure for kids to be diagnosed because hyperactive boys can be disruptive, especially in school environments.

As out there as this may sound, I think we are as a culture cheating boys of their inherent natures and I have real questions about how that affects their psychosocial development long-term and what it will all mean for manhood a couple of generations down the road (I'm concerned about comparable issues with girls as well). What's more, I think the educational system places too much emphasis on having quiet, compliant kids—far more so than in the past. When I was a kid in the 1970s, boys were pretty much allowed to engage in all kinds of wildness at recess in elementary school and after school, but from what I hear that's being discouraged today. Why the change I couldn't say, but I do know that there's been a real push in our culture to silence outward signs of male aggressiveness, both in kids and adults.

As for parents, I think they are under a lot of self-imposed pressure to have perfect kids with high grades who get into top universities or they've somehow failed as parents. The ADHD drugs and the diagnosis itself have been foisted on them as a way to have their kids better liked among school peers and to achieve higher grades and perform better on the many, many standardized tests kids must take these days. What's interesting to me is that parents and our culture may well have been sold a bill of goods here, as the recently released MTA study (a long-term tracking study of kids through teens with ADHD, both on and off-meds) showed that long-term treatment with stimulants didn't appreciably improve GPAs and other test scores.

For the full interview, click here.