«Sally Patton UNITARIAN UNIVERSALIST ASSOCIATION BOSTON Copyright © 2004 by the Unitarian Universalist Association of Congregations. All rights ...»
• Sensitivity to stimuli: Bipolar children are excruciatingly sensitive to stimuli of many types: “It’s as if the arousal system of the child is set at such a threshold that any kind of physical sensation that is not ‘just right’ is extremely irritating and threatens a sense of bodily integrity.”8
• Problems with peers: Bipolar children are usually not very popular with their peers. They are seen as bossy and intrusive.
They miss social cues and can be overwhelmingly aggressive.
• Temperature dysregulation: These children are reactive to cold and heat. For example, in the winter, they may be always hot even when everyone else is cold.
• Cravings for carbohydrates and sweets: Bipolar children have excessive cravings for sugar and desserts. They also have food aversions. This pattern is similar to the findings about children with developmental and learning disorders. Clearly, children who are struggling have difficulties with their nutritional balance. It is unclear whether this nutritional imbalance is caused by the disorder or triggers certain behavior common to specific disorders. For example, sugar cravings may indicate an underlying Candida problem (an imbalance of the healthy bacteria in the colon exacerbated by high levels of sugar intake), or children may be subconsciously using sugar to give them a needed boost when they are depressed.
What is clear is the need for good nutritional support.
128 Welcoming Children
• Bed wetting and soiling: Why these children have difficulties with bed wetting or soiling is not understood. However, the problem can persist for years.
• Impending mania: As bipolar children start to become manic, they shift dramatically and frequently, so their families can never know what to expect.
• Hallucinations: Not all children who become manic suffer from hallucinations, but some do. Children and adolescents are more likely than adults to have the psychotic features of hallucinations, grandiose thinking, and delusions. Children can experience both auditory and visual hallucinations. Their hallucinations are different, however, from the hallucinations of schizophrenia. Unlike someone with schizophrenia, bipolar children are more likely to realize that what they are experiencing is not normal. In addition, bipolar children’s swings are sudden, and their affect is more emotional than the blunt affect of the person with schizophrenia.9 The schizophrenic person’s disordered thoughts, hallucinations, and delusions are much more persistent and incapacitating than those of someone with bipolar disorder.
• Suicidal ideas: The rate of suicide among people with bipolar disorder is high. One study found that 58 percent of patients with manic depression tried suicide at least once.10 Suicide is the thirdleading cause of death for people between the ages of fifteen and twenty-four.11 One-third of people with bipolar disorder commit suicide, and some believe the figure is even higher if we include people with bipolar disorder who overdose with drugs.12 Therefore, it is especially critical to be ever vigilant for signs of suicidal thinking in bipolar adolescents.
While eating disorders are not usually included with mood disorders, they are closely related to depression and its associated feelings of anxiety and anger. Moreover, the prevalence of eating disorders has reached an epidemic level in the United States.
The National Association of Anorexia Nervosa and Associated 129 Mood Disorders Disorders (ANAD) estimates that 7 million women and 1 million men have an eating disorder. Adolescents are particularly prone to these disorders; approximately 1 in 2,400 are affected. More than 90 percent of anorexics are female, and 86 percent report the onset of an eating disorder by the age of twenty. About 6 percent of the most serious cases end in death.13
There are three categories of eating disorders:
• Anorexia nervosa is often characterized as self-starvation. Girls and boys with anorexia nervosa are afraid of gaining weight and have an intense need to be thin. Their body image is poor and often distorted, so that they feel they look fat when they are actually extremely thin. Youth with anorexia nervosa control their weight through excessive dieting, self-induced vomiting, and/or misuse of diuretics and laxatives.
• Bulimia nervosa is characterized by recurring episodes of binge eating, in which large amounts of food are consumed in a short time period, usually followed by purging through selfinduced vomiting or misuse of diuretics and laxatives. Some youth do not purge but go on extreme diets to control the weight gain.
People with bulimia nervosa know that they are overeating but cannot stop themselves. They feel guilty and depressed afterward, which leads to the purging. Unlike someone with anorexia, a person with bulimia usually has normal weight.
• Compulsive overeating (or binge-eating) disorder is characterized by uncontrollable overeating without purging. Compulsive overeaters become overweight. Some consume large amounts of food in one sitting, while others eat steadily throughout the day.
Discussion The idea that children can become depressed goes against all our feelings about childhood. Childhood is supposed to be a time of innocence—a time for play, curiosity, and learning. We want to 130 Welcoming Children believe that children have not experienced enough of life or are not emotionally mature enough to become depressed. We know that children become sad, but we hope and expect that they move on. Unfortunately, they don’t always, and we now know that children can suffer major depression and bipolar disorder.
In fact, the last ten years have seen a dramatic increase in the number of people, particularly children, treated for these conditions. A current theory suggests that some people are born with a predisposition to mood disorders and that a combination of environmental and social events can trigger debilitating mood disorders in children. What causes this predisposition to mood disorders is open to debate and interpretation.
Some experts believe that children’s brain chemistry predisposes them to depression or bipolar disorder, while others believe that these conditions are a response to overwhelming stress. Many factors can enter into a child’s mood disorder, including nutrition, environmental and social factors, brain chemistry, and a bad fit between temperament and parenting styles. The identification of these factors often directs which therapies will be used to treat the child’s disorder. The most common treatments are medication and cognitive, interpersonal, play, behavior, family, and group approaches to psychotherapy.
The common use of medication reflects the widespread belief among experts that the chemistry of the brain underlies depression. This is why mood disorders are often treated with medications that affect the neurochemical functions in the brain.
Many people taking such medications experience improvement in behaviors and feelings. Some feel they would not be able to participate in other therapeutic strategies without medication.
However, others have found medication ineffective or even counterproductive. Medicating children is especially controversial.
Not all of the experts who believe that brain chemistry affects depression advocate medication. Some offer different approaches to healing. In Toxic Psychiatry, psychiatrist Peter Breggin says that depression and bipolar disorder are responses to a psychospiritual 131 Mood Disorders crisis—a moral and social phenomenon that can be understood in the context of basic human needs and strivings.14 He believes that psychiatric labels refer to human conditions that cannot be pigeonholed because they are not diseases but subjective experiences. In contrast to many psychiatrists, Breggin feels that medication cannot solve these problems and often makes them worse because they can damage the brain.
Barry Neil Kaufman suggests that we can change the chemicals in our brains by choosing to think positively. In his book Happiness Is a Choice, he writes, The human organism is not simply a lifeless heap into which the soul breathes life. We can put aside the antiquated view of body separate from mind and replace it with more valid perception—bodymind!... Thinking has physical substance in the form of neurotransmitters and neuropeptides, visible chemical substances which are not confined to the brain but operate body-wide.... In creating new thoughts or revising old ones, we change the actual physiology of the entire body system in an instant. Atoms and molecules realign and readjust immediately. New biochemical and cellular configurations pop into existence. The mind is everywhere, and we can change ourselves dramatically and profoundly by simply changing our minds.15 Interestingly, research has borne out this idea. In an experiment by Dr. Andrew Leuchter at the University of California in Los Angeles, people who took placebos for depression showed marked improvement, but when they discovered they were taking a placebo, their depression returned.16 Kaufman’s premise is similar to the philosophy behind cognitive therapy, which the mental health community commonly uses to treat children with mood disorders. Cognitive therapy is based on the belief that how a person thinks can create depressive or manic thought patterns, negative self-images, and false assumptions that affect behavior. The goal of cognitive therapy is 132 Welcoming Children therefore to help the child break free from these negative thought patterns and emotions in order to stop the recurrence of the mood disorder. Strategies include using positive affirmations, substituting positive thoughts for negative thoughts, and consulting with a trusted adult when negative thoughts arise. According to Waltz, there is growing evidence that cognitive therapy can produce physical changes in the brain, such as changes in the production and absorption of neurotransmitters.17 In his book There’s a Spiritual Solution to Every Problem,
Wayne Dyer offers this explanation:
In the low energy of depression, we identify or diagnose the chemical imbalances that result and conclude that we need to restore that chemistry to its natural harmonious level. We pour chemicals into our bodies and we see some changes, less despair, more harmony, less tension, more cheerfulness.
We conclude that depression is cured with drugs and chemicals. Why the body-mind is out of balance should have been the first question. Depression, like stress, is internally generated by one’s attitudes. Could it be that one crucial ingredient that represents a spiritual solution to this massive problem of depression is hope?18 Debra Whiting Alexander agrees that nurturing the spiritual life of a child who is depressed or suffering from trauma can help restore his or her heart, mind, body, and soul. In her book Children Changed by Trauma, she suggests three basic strategies: listen carefully, respond genuinely, and restore hope continuously.19 Dyer says, “When your emphasis is the inner spiritual energy of love, peace, rejoicing, cheerfulness, celebration, and kindness, you cannot know debilitating depression.... In a sense, hope is the restoration of the appetite for life itself.”20 We can provide spiritual nourishment and a sense of hope in our ministry to children and their families. And in doing so, we can also replenish our own sense of optimism.
133 Mood Disorders Ministering to Families Depression in children was not officially acknowledged until 1980.
Blaming parents for children’s mood disorders was common practice and still occurs today. This blame can cause parents immense heartache and prevent them from obtaining effective treatment for their children. While parenting obviously has an effect on the emotional health of children, mood disorders are caused by a combination of biological, environmental, psychological, spiritual, social, and familial factors.
Religious educators and ministers need to be aware that stigma and misunderstanding continue to surround behavioral and emotional disorders. It is still easy to feel that people who are depressed are weak and just need “to get their act together.” Friends and family may get frustrated or angry with them when they cannot turn things around on their own. As a result, many people who are depressed feel ashamed about seeking help. Parents, in particular, may hesitate to seek treatment for their children out of fear that they will be judged as bad parents who caused their child’s mood disorder. As religious educators and ministers, we need to be aware of these fears. Our support, acceptance, and understanding are critical.
While we need to be careful about assigning a label to a child, an accurate diagnosis is vitally important in order to obtain effective treatment for a mood disorder. Bipolar children can be helped tremendously with early and accurate diagnosis and subsequent treatment. But without treatment, self-esteem plummets, the manic and depressive moods become much more severe, and eventually substance abuse and/or suicide become possibilities.
Usually, manic depression is diagnosed when a child is in his or her teens. By that time, however, the child and his or her family have been through years of agony with many diagnoses and little relief. In His Bright Light, Danielle Steel writes compellingly of her son’s struggle with manic depression from infancy, to his diagnosis at age fifteen, to his suicide at nineteen.21 Her son, Nick Traina, 134 Welcoming Children cycled back and forth between states of incredible creative energy and anger and deep, dark depression. Steel’s story of her constant struggle to find help for her son conveys how difficult it is for parents to find help for their children with bipolar disorder from professionals with differing methods of treatment.