According the NPR health blog “Shots,” three psychiatrists at Harvard University who were leaders in research on bipolar disorder in children were punished over not disclosing payments from drug companies for research and other activities totaling more than $4.2 million dollars. (See “Harvard Punishes 3 Psychiatrists Over Undisclosed Industry Pay,” by Richard Knox.) The psychiatrists cannot accept any payments from industry for one year and must seek approval for any such payments after that period. Additionally they will suffer a “delay of consideration” for promotions and advancements in their institutions.

The doctors’ public response to this suggests that they felt that they operated in good faith and that they now realize they should have paid more attention to the details regarding disclosure.

As a psychiatrist, every day I encounter families struggling with mental illness, especially in their children whose lives range from disrupted to shattered as a consequence of these challenges. In these daily battles I’m most frustrated and saddened by the jaw-dropping lack of compassion surrounding me and my patients regarding their family struggles and their child’s distress.

Unfortunately, many people still view mental illness as a moral rather than a medical or developmental issue. As a result, they readily dispense judgment when someone is struggling with emotional and behavioral symptoms – shutting down open discussion and squashing attempts to problem solve rather than blame.

Even worse, stigma and misunderstanding paralyze many people who might consider seeking help but don’t because they’re afraid of being judged or feel somehow to blame. Families are told they’re being manipulated by their loved one who’s suffering or that their parenting is impaired. Just “try harder” says the teacher, the coach, the neighbor, and the in-laws.

At times, I become resentful that bipolar disorder occupies any part of my life, but because it does and because writing about is one of the things I do, I sort of accept that it’s going to occupy a corner in my mind.

Some time ago, when Candida and I were having trouble cooking up ideas for blog posts, I asked my wife Cecie to help us drum up some topic ideas. Soon, we were talking about bipolar disorder every day. We read books, articles, and research studies about bipolar. We even watched a couple movies and videos. I began to notice that when friends or family members asked what we had been up to lately, the topic turned to bipolar disorder.

In a letter to the editor of the Journal of the American Psychiatric Association , printed November 2010, Alan Eppel, M.B., F.R.C.P.C. cites an article published in the July 2010 issue of the journal that examined the use of antidepressants in bipolar II disorder. Mr. Eppel questions the clinical significance of the results of the study and claims the study adds “more fuel to the three-decades old debate between those who advocate minimal use of antidepressants in the treatment of bipolar disorder and those who favor maximal usage.”

Debate continues to swirl among psychiatrists about the risks/benefits of antidepressant use in bipolar. The July article suggests people with bipolar II who take antidepressants as opposed to lithium or placebo have a longer interval before relapsing into a depressive episode.

Last week I did a post entitled “Supportive Catch Phrases That Make My Blood Boil.” It generated some great discussion, and I thank all of you who posted such insightful comments. Venting like this helps me keep a sense of humor when I’m feeling the sting, and many of your comments made me smile, some made me laugh, and a few made me think that maybe my feelings were misdirected.

A couple people were obviously upset. I noticed on our Facebook page that we lost a few people who previously “liked” the page. I’m sorry to see that, but I can understand why some people may have been turned off. It just goes to show that I’m not always the most sensitive person on the planet either.

Over the course of my family’s experience with bipolar, I have been on the receiving end of plenty of excellent information and advice. I’ve also heard several phrases intended to help us deal with painful, overwhelming situations that I have come to despise. Here are a few:

“Hang in there.”

“God never gives you more than you can handle.”

“Don’t take it personally.”

Lately, we’ve noticed many articles floating around the Web about the fact that bipolar disorder is not associated with increased incidents of violent crime. Most, if not all, of these articles are in response to a study published in the Archives of General Psychiatry (September, 2010) entitled “Bipolar Disorder and Violent Crime.” In this study, researchers arrived at the following conclusion:

Although current guidelines for the management of individuals with bipolar disorder do not recommend routine risk assessment for violence, this assertion may need review in patients with comorbid substance abuse.

In other words, if any connection is to be made between bipolar disorder and violent crime, it’s not the bipolar disorder causing the problem. An increased risk of violence is constrained almost entirely to instances in which alcohol or substance abuse is also at work.

As more and more celebrities talk openly about living with bipolar disorder, the diagnosis is not only becoming more common – it’s becoming downright popular. The March issue of The Psychiatrist carries an article entitled “‘I want to be bipolar’… a new phenomenon,” in which authors Diana Chan and Lester Sireling point out the following:

Despite the stigma attached to mental illness, we have noticed in our clinical practice a new and unusual phenomenon, where patients present to psychiatrists with self-diagnosed bipolar disorder.

Personally, I think the title of the article is a tad bit misleading. People don’t generally want serious medical conditions. A more accurate reason behind this phenomenon is that when people feel bad, they yearn for an explanation.

Rebecca Riley was four years old when she died three years ago. She had been diagnosed as having bipolar disorder and ADHD and was being treated with clonidine (a blood pressure medicine sometimes used as a sedative for ADHD) and Depakote (for bipolar). (See the Department of Social Services (DSS) case file recounting the timeline of DSS involvement with the family of 4-year-old Rebecca Riley.)

On Tuesday, February 9th, after 19 hours of deliberation, a jury found Rebecca Riley’s mother, Carolyn Riley, guilty of second degree murder in Rebecca’s death in December 2006 due to an overdose of psychiatric medication. It made me sad to read this, mostly because it doesn’t bring Rebecca back and it doesn’t solve the bigger problems raised by this case. The system – including many well meaning and caring individuals – failed Rebecca, and these failures killed her. Rebecca’s mother appears to have been so broken that she could not effectively keep her daughter safe. But that is why we look to the village – to our systems of care, education, social services, family, and neighbors – to keep a safety net under children who are not safe in their parents’ care.