- The Washington Times - Tuesday, March 8, 2005

Alex crouched by New Jersey railroad tracks, waiting for a train to run over his 11-year-old body. “I’m going to stand in front of the train

and die,” he screamed to his father.

Paul Raeburn begged his son to come home.

“I didn’t know what he would do,” Mr. Raeburn said. “[I was] waiting to hear the train whistle or see the light down at the end of the tracks.”

But nothing came, and Mr. Raeburn called the police.

Soon he sat with his son in a small bare room with green metal desks, thinking back to the days when his boy played baseball and built model cars.

Now Alex just wanted to die.

He is one of about 15 million American children and teenagers who suffer from a diagnosable mental illness each year, according to the U.S. surgeon general.

Alex puts a face to the rising number of boys and girls specifically diagnosed with bipolar disorder, also known as manic-depressive illness, which strikes more than 2 million American adults yearly, according to the National Institute of Mental Health.

“It’s a hidden epidemic,” wrote Mr. Raeburn, a former Business Week editor whose tale is told in his 2004 book, “Acquainted with the Night: A Parent’s Quest to Understand Depression and Bipolar Disorder in His Children.”

“Millions of families are alone in coping with the ordeal of children’s mental illness, unaware of how many others are struggling, too,” Mr. Raeburn said. “We all know what it means to sit alone, at night, with a child who might at any moment take a swing at us or another of our children, or run out the back door, or grab a kitchen knife, or swallow a bottle of pills.”

The brain disorder, which doctors usually diagnose in teens and adults, causes vicious mood swings, making children change from hyper to hopeless, rowdy to restless, and back again.

Bipolar has been known since at least A.D. 150, when it was described by the Greek physician Aretaeus of Cappadocia. Many believe Vincent van Gogh, Edgar Allan Poe and Ernest Hemingway all shared the illness. Despite this historical knowledge, scientists have found no test for bipolar.

Even the National Institute of Mental Health reported in 2000 that the disorder is difficult to diagnose because its symptoms often resemble normal emotions and behaviors most children experience, including talking very fast and sleep disturbances.

“In psychiatry, diagnoses overlap and flow into one another, blurring like the colors on an artist’s palette,” Mr. Raeburn wrote. “There is no measure for depression, no blood test to identify schizophrenia or mania.”

So children go from up to down, high to low, until another pill is popped in the mouth, or a little foot steps onto the tracks — this time without a father to call it back home.

Despite this danger, another dark trend in mental health has grown with the rising number of children diagnosed with bipolar: the lack of help to support them.

Consider the numbers: Of the 6 million to 9 million children and adolescents with serious emotional disturbances, including bipolar, three-fourths fail to receive mental health care, and most receive none at all, according to the U.S. surgeon general.

One cause could be the declining number of hospitals.

Occupancy rates for children and teenagers in both psychiatric and general hospitals with mental health units increased by more than 30 percent from 1997 to 2001 — the highest levels ever — according to Mark Covall, executive director of the National Association of Psychiatric Health Systems.

At the same time, the number of private psychiatric hospitals fell from 460 in 1995 to just 265 in 2002.

This shortage has been intensified by a severe lack of child psychiatrists. In 1990, a committee of medical school educators found that the nation would need 30,000 child psychiatrists by 2000. There are now only about 6,300 in the United States, and that number hasn’t changed in a decade.

Massachusetts holds the largest number of child psychiatrists of any state: one for every 5,300 children. Mississippi has the fewest — one for every 125,000.

“Too many families know what it’s like to lose a child because they couldn’t find help in time,” Mr. Raeburn wrote. “Children and adolescents with mental illness are among the most neglected and mistreated members of our society.”

Mr. Raeburn’s son is just one of millions. The first psychiatrist he saw said the boy was suffering from depression — after just a 20-minute interview.

The doctor scribbled a prescription for Mellaril, a 50-year-old drug originally used for schizophrenia.

Alex got worse. He talked about wanting to harm himself and didn’t feel like coming to see a “shrink” and taking “stupid pills,” the psychiatrist wrote in Alex’s record.

So he changed the diagnosis. Instead of depression, this time it was “adjustment reaction of childhood with mixed features and intermittent explosive disorder.”

“I might not have used the same words, but I could have come up with that ‘diagnosis’ myself,” Mr. Raeburn wrote. “I began to get a sense of how imprecise and subjective psychiatric treatment can be.”

After Alex’s second visit, the doctor decided to cut back from the Mellaril and start Alex on Zoloft, an antidepressant.

He became suicidal.

“I’ll be dead by morning!” Alex screamed to his mother one night shortly after taking Zoloft.

“Please come home,” she said, crying as her son ran outside. “Don’t do this to us, to your family.”

“I don’t have a family,” Alex said, smiling. “I want to be up in the sky on my own private cloud.”

Then he paused, and something changed. The smile died, and he began to shiver uncontrollably.

“Was that really me out there?” Alex asked. “What happened to me?”

Over the next few years, Alex saw seven different psychiatrists and took eight different drugs.

While most bipolar children now take Lithium or Depakote, to this day researchers still do not know exactly how these drugs work.

Others see problems with putting children on drugs.

Larry Barber, a marriage and family therapist from Eugene, Ore., said prescribing them is easy, but it treats people as mere chemicals reacting to one another, without an emotional or spiritual side.

“It’s like getting a lobotomy,” Mr. Barber said. “It just so dulls and blunts your ability to function. It’s like the lights are on, but nobody is home.”

Despite the medical debate, Alex Raeburn, who still takes Depakote but is now a 20-year-old college sophomore, has learned how to deal with bipolar — the illness that will always remain a part of him.

“It affects every aspect of my life, almost all of the time,” Alex wrote in a class paper he titled, “Who Am I?” “[But] there is much more to me than this illness. I love writing and the outdoors. … I’ll sit in a field and watch the trees blow in the wind, and that is all I need to get me by. You can find the beauty in everything. Even the simplest things.”

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