(+++) STRAIGHT TALK ON AN UP-AND-DOWN ILLNESS

Bipolar Kids: Helping Your Child Find Calm in the Mood Storm. By Rosalie Greenberg, M.D. Da Capo. $26.

      If you have a child with bipolar disorder – still sometimes called manic depression – you definitely want Dr. Rosalie Greenberg in your corner. The clinical case histories she discuses show her to be a thoughtful, concerned and adept psychiatrist, not bound by any specific set of rules except to help her young patients. As past president of the Juvenile Bipolar Research Foundation, Dr. Greenberg has a strong commitment to understanding this disease and doing a better job of treating children who have it.

      But which children have it? Diagnosis is complicated, since the symptoms are not necessarily the same as in adult bipolar disorder. And how is it best treated? Dr. Greenberg has a psychopharmaceutical orientation – she is concerned more with finding the right drugs to administer than with looking for alternative, non-drug treatments. And yet she writes that “a major part of our job as doctors, therapists, or parents often boils down to ‘professional listening.’ Do a child’s words indicate that he’s more angry than usual? That nothing seems to please him? That things that once made him happy no longer do? …The small change of daily life is what determines one’s repository of psychological wealth – and what gives me significant clues to a child’s state of mind.”

      Everything Dr. Greenberg writes is calm and reasonable, but life with a bipolar child – or one with any serious mental or emotional condition – does not give parents much time for reasonableness in coping with “the small change of daily life.” Dr. Greenberg is, if anything, too reasonable. She explains, for example, the diagnostic possibilities inherent in the way a child throws a temper tantrum. If the child tells her mother such things as, “You’re mean, stupid and very ugly. You never listen to me,” then she feels she is a victim. But if she says such things as “I wish you were dead. I wish a car would run over you and kill you,” she feels her mother is the problem and is directing her rage externally. True and very helpful – if you are a doctor who is present during the tantrum and can see past the emotion and out-of-control hurtfulness to the underlying words. But for the parents of this hypothetical child, or the many real children with bipolar disorder, how in the world can this information be used? It is in this way that Dr. Greenberg falls short – not in caring or in skill, but in real-world connectivity.

      Actually, that is too harsh – Dr. Greenberg certainly does tell parents what real-world solutions and approaches are open to them and their children. And parents fortunate enough to be working with Dr. Greenberg or an equally empathetic therapist will find this book a useful reference work. But most parents, especially ones unsure where to turn, will get less from it. Consider, for example, Dr. Greenberg’s oh-so-reasonable Q&A section about inpatient hospitalization. It starts with a matter-of-fact statement that “if there is an acute emergency, police generally take the youngster to the nearest psychiatric emergency screening center or to the local emergency room.” Contrast the wealth of fears and worries attacking the family at that time with the deliberate blandness of Dr. Greenberg’s prose and you see the disconnection between her writing and what families experience in the situations she describes. The questions and answers themselves often gloss over very serious problems: “With privacy concerns paramount these days, hospitals typically do not allow visits to inpatient units because it might violate patients’ rights to confidentiality.” In real life, that means families must admit a deeply distressed, even potentially suicidal child to a psychiatric hospital without being allowed to see it first – a hugely traumatic decision to which Dr. Greenberg gives short shrift.

      Bipolar Kids is a thoughtful, comprehensive and caring book, and even poetic at times, as when Dr. Greenberg talks about how Edgar Allan Poe’s poem “Alone” may “ring eerily true to bipolar kids,” with its tolling lines, “And all I loved—I loved alone.” But parents, the people who will read the book, may wish that more of the author’s considerable skill at dealing with medical and pharmaceutical treatment of bipolar children could be used to help families, as well as children, “find calm in the mood storm.” After all, it is the families that must live with their bipolar children day in and day out.