Telling People What they Don’t Want to Hear

While browsing my Twitter feed (hi to those of you who have joined in the past couple of days btw) I came across this radio interview with Dr Allen Frances, an American child psychiatrist talking about paediatric bipolar disorder.

He’s surprisingly frank about the reasons why large numbers of American kids suddenly started being diagnosed as bipolar – over-zealous clinicians, aggressive marketing by drug companies, widespread ignoring of the DSM-IV criteria for bipolar disorder. All of which led to a lot of kids being prescribed frightening doses of antipsychotics, with all the side effects that come as part of the package. The overwhelming majority of those kids almost certainly didn’t have bipolar disorder.

I’m happy to say it’s a trend (Frances calls it a “fad diagnosis”) that never really took off in Britain. Nor for that matter, anywhere else in the world. Since coming to CAMHS I’ve seen very few patients with a bipolar diagnosis, and nearly all of those were around the 16-17 age range.

Frances is also very frank about the dangers of looking for a simple, elegant solution to complex, multi-faceted problems. He cautions about the limitations of psychiatric knowledge, and points out that often psychotherapy, parent training or just plain old watchful waiting need to be tried before reaching for a prescription pad.

What also surprised me about this interview was the extent to which the host doesn’t seem to want to hear it. I get the impression she was expecting him to come on the show and wow the audience with the latest discoveries and wonder drugs for paediatric bipolar disorder. He tries to point out that it’s really not that simple, but he has to hammer his points home because at times it all just seems to be going over her head.

I guess not everybody wants to be told that some problems can’t be solved with a pill.


3 responses to “Telling People What they Don’t Want to Hear

  1. Diagnosing serious “grown up” mental illnesses in kids is scary business, and often the result of carelessness or desire for an “easy answer” on the part of the clinician. Thanks for sharing the video link. – Natalie (

  2. hi i work in EIPS so work with young people aged 14 – 35 yrs, a lot of parents i meet are under the impression that if their children go into hospital ‘we’ can ‘fix them’ and they will come out of hospital ‘mended’. failing that they hope that a diagnosis will also lead to magic treatment that can ‘cure’them – if only life was that simple !
    the american system of diagnosing kids from the age of 5 yrs and px them major psych drugs is disturbing. -isn’t it common to have imaginary friends when you are young and to have mood swings?
    just out of interest do you see ODD diagnosed much in your CAMHS? we had one young man aged 18ish who was diagnosed with it in his early teens and prscribed risperidone and others for it – luckily our camhs doctor fought hard with mum and dad when he was 14yrs to reduce the amount of meds he was on.
    great blog by the way !

    • We do have ODD diagnosed, though our doctors tend to be reluctant to diagnose it unless it’s co-morbid with something like ADHD or ASD. One thing they tend to be conscious of is the question, “What will the child get in return for this diagnosis?” They’re very aware of the way ODD diagnoses can do more to stigmatise and label than help, so tend to use it with caution.

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