Heroes in mental health
THE STORIES are heart-wrenching and painful. They come from tearful and desperate parents who describe children so intensely unstable in mood, so irritable, angry and violent, and so out of control that they are tormenting -- indeed, ripping apart -- themselves and their loved ones. Home is a living hell for these families.
Few truly understand the anguish they feel because, fortunately, most of us are spared from witnessing such suffering. Parents struggle to contain the chaos, trying to give their children some semblance of a normal life before precious childhood slips by. These parents search relentlessly for ways to stop their children from abusing drugs, starting fires and hurting themselves and others. They are frantic to protect their children from emerging into adulthood scarred by years of pain, rejection, and despair.
These are parents who reach out to Drs. Joseph Biederman and Janet Wozniak at Massachusetts General Hospital. These physicians are heroes to families of children with serious mental illness. Amid a firestorm of stinging and misdirected criticism, these physicians look to science to serve up hope. They use limited tools available to them -- medications, talk therapies, behavioral strategies -- to help children. Success stories -- and there are many -- are heartwarming and inspiring.
Emerging research shows that differences in brain structure and function as well as differences in genes underlie the vulnerability of these children to mental illness. Physicians who study and treat these patients know that very young children can have serious psychiatric issues, including bipolar disorder. Clearly, psychiatric disorders that afflict adults do not magically appear on the 18th birthday. Rather, susceptibility to mental illness can manifest early in life. For bipolar disorder, new findings from a study funded by the National Institute for Mental Health show that 60 percent of adults with bipolar disorder reported symptoms before age 18, and 28 percent before age 13.
Yet, many in the media and those without training and experience in child mental health have ignored science and fact to exploit a child's tragic death to promote a biased agenda. Four-year-old Rebecca Riley allegedly died of an overdose given to her by her parents, a tragedy that has little to do with any specific disorder. Rather, her death appears to be caused by the parents' misuse of medications. If a child with seizures or asthma were to be given a fatal overdose of medication, would a life-saving therapy and an entire medical discipline be attacked so viciously? It is appalling that Biederman's distinguished lifelong work caring for children has been dragged into this fray.
Biederman is the most widely cited child psychiatry researcher in the scientific literature. He has moved the field of child psychiatry forward carefully, deliberately. Unlike his critics, his meticulous research has withstood intense peer-review scrutiny, and his work is backed up with rigorous science. He does not use dramatic claims or horrific allegations directed at others. He is not a self-proclaimed expert with a book to sell. Rather, he has earned -- and continues to earn -- the respect and admiration of his professional peers through his critical academic work and his outstanding clinical practice.
Most important, he has the love and gratitude of those he has helped. Biederman's personal mission is to offer children and families hope where little has existed in the past. He is not a businessman or a politician. He is a dedicated physician, a medical pioneer. His passion is for the patients and families he works so hard to save, to restore.
Let's get the facts right. Joe Biederman had no involvement in the tragic death of Rebecca Riley. He had no knowledge of this child's diagnosis, no role in developing the treatment alleged to have been administered by the parents.
Despite the imbalanced and sensational media coverage, and despite the attempts of misguided critics, Biederman and others must -- and will -- persevere in this field because it is the right thing to do. No, it is not Biederman who suffers most from the preposterous allegations set forth. Sadly, the greatest losers are children with mental illness and families, who, as a result of the proliferation of misinformation and the deepening of a stigma, could feel too embarrassed and ashamed to seek the life-saving help they so desperately need.
Dr. Jerrold F. Rosenbaum is chief of psychiatry at the Massachusetts General Hospital. Dr. Michael S. Jellinek is the chief of child psychiatry at MGH. 
