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How do you treat a child with bypolar disorder?

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Family Interaction

"I took a knife out of the drawer, it was maybe six, seven, maybe eight inches long and really sharp. I went outside to our wooden deck, and just took it and boom, right into the deck. Big gashes and my mom flipped. I told her, 'You told me that if I ever get mad, to just take a dish and break it on a tree or whatever.' 'But I don't want you doing that!' 'Whatever.' 'Don't ruin my house!' 'Whatever, leave me alone. Here's your knife.'" - Erin

"She'll get like all freaked out over nothing. Like I put the mattress on the floor the other day to go to sleep. 'Why'd you do that? You had no reason to do that!'" - Athena

"My parents did a really good job like, they're always like studying, and what medications do what, and they've learned all the vocabulary of mania or whatever." - Eric

"They've never done everything right, but they try. I have to give them credit for that." - Erin

Erin, her mother Sherry, and their dog.
photo by Steve Schapiro

One of the hardest things about loving a child with bipolar disorder is that, quite frankly, they aren't always lovable.

"I mean right now, things are quiet in the house," says Sherry. "You know, I can let my guard down. And every time that happens, she throws a monkey wrench in and stirs up the waters. And, you know she lets us know, 'Hey, I'm back.'"

Sherry and Erin have had a rough couple of years, beyond what you'd expect between a rebellious teenager and her mother. Erin is just back from her second hospital stay in two months. Police took her to a psychiatric unit by force.

"I had to call the police because she almost hit me," says Sherry. She and Erin, sitting next to each other on a couch but looking straight ahead, still can't agree on what happened.

"She knew I wasn't gonna hit her," says Erin. "I wasn't even facing her when I raised my hand. I wasn't even raising my hand. I was picking up the phone and throwing it."

"When you have a kid who's being very nasty to you, has threatened you physically, and is making it difficult to parent your other kids, embarrassing you in public, yeah, eventually parents are gonna say - feel like they don't like the kid anymore," says psychiatrist David Miklowitz. "When they try to set limits on a kid who's really raging, it seems to make things worse, and so they end up feeling like they're walking on eggshells to not provoke the kid."

Sherri has tried to give Erin space to express herself, including physical space. We go up the steep stairs of this earth-toned split level house, come to a wall of beads, and enter an arresting bedroom.

"Every inch of Erin's wall is full of magazine pictures and comics," says Sherry. "All of them of violence. There are skulls on her walls, there's, uh, people with skin being torn off on her walls, her pop idol is Kurt Cobain. I, she thinks he's fabulous. He killed himself and you know that's someone to have as an idol."

Cobain was the Nirvana lead singer who shot himself in 1994. Erin's room is full of photos of his anguished face, screaming into a microphone. His song lyrics are scrawled on Erin's walls.

"In large type, it says, 'Pain, pain, pain, you know you're right, you know you're right.' I guess that's the chorus," says Sherry.

"All his music speaks to what I feel," says Erin.

Among the band posters, she's hung a few dark, atmospheric paintings including a self-portrait.

Erin describes, "One eye is yellow and orange and red, and the other is green and blue and black, and it's just, I don't know, two different moods."

Erin spends most of her afternoons in this room. That's her parents' rule following a year-long downward spiral. They discovered she was abusing drugs and alcohol and not taking her psychiatric medication. She was arrested for being drunk and disorderly, and then raped by a boy she knew. Erin says she stopped the drugs and drinking, but things continued to deteriorate.

"Recently I've been really anxious, and really depressed, and unable to sit still and focus and do everyday stuff," says Erin. "So I decide I need to intervene in my life, my own life, and checked myself into a hospital."

She was placed in an adult psychiatric unit with elderly dementia patients and traumatized veterans. Sherry says it was frightening for Erin, now old enough to be admitted as an adult but still a child, in so many ways.

Sherry describes Erin's room. "You know with all this violence, you can look around and still see teddy bears, dolls that she won't get rid of, there's still a little piece of her inside that's - I think that wants to be a little girl. I think in a way, she missed being a little girl. She had so much turmoil in her that she had to deal with it like an adult."

Conni Rancke offers tea as Eric explains that they have many options.

The fact that Eric and Conni Rancke can sit politely in their kitchen and offer refreshments is a sign they're past the worst of Eric's illness. At least Conni hopes so.

"I can't tell you for how many years we didn't go out. We didn't invite people over," says Conni. "Somebody from work invited us to Easter dinner, which was a really lovely thing. Well, we got up that day, and Eric was a mess, and I had to call these people. I didn't know them well, so I wasn't comfortable saying, 'My son is bipolar and he is severely depressed today so we won't be coming.' So, I just called and said, 'I'm sorry we can't come.' People don't invite you anymore."

Now, Eric has sleep-overs with friends. Even holidays with extended family have become bearable. But Conni still takes nothing for granted. Eric recently felt well enough to start cutting back on his lithium, and when he did, Conni noticed some backsliding.

"Something was going on, and he was getting out the door, and I was trying to get him to take his pills or do something normal in his morning routine," says Conni. "And he was not happy, and took everything in his arms, his books and lunch, and threw them onto the floor, and stomped on them."

"I don't remember what happened much," Eric confesses. "When those things happen, I kind of block them out of my head."

"He doesn't remember any of the stuff from when he was little. It's kind of like an epileptic seizure. But I also think, to some extent, it's sort of a coping mechanism, and he needs to move and get back to his level self," says Conni.

It's not uncommon for parents of bipolar children to have a mental illness themselves. Athena's mom, Mary, also has bipolar disorder, which she says helps her understand Athena. But, it doesn't necessarily help her raise Athena.

"If our moods are opposite, then we'll fight," explains Mary. "If we're both in the wrong mood at the same time we can clash there, too. If we're both in a mania, and we've got energy and someplace to go, something to do, then we get along fabulous. It's a fantastic day."

Athena navigates through her kitchen.
photo by Steve Schapiro

In their trailer, piles of papers, empty soda bottles, pizza boxes, and clothing take up almost every inch of floor space. Dirty dishes and loose cereal are scattered through the rooms.

"I've been trying to find my summer clothes," says Mary, "so I have the boxes all sitting underneath other boxes here - Athena's toys."

There is cereal on the floor.

"Yeah, it looks like the box got kicked off the end of the bed, or knocked off by one of the cats. One or the other," explains Mary.

Amid this clutter, they have a snake, a hamster, two parakeets, and four cats. These days, Athena plays more with her pets than with other kids. Her mood swings have turned her into a social outcast.

"She was invited to a birthday party by a friend," says Mary. "This girl then invited some other kids from the class. Those kids said they wouldn't go if Athena went, so she uninvited Athena."

Athena has one friend who's stuck by her: Sarah Guernelli. She's visiting this afternoon, and plops down on Athena's bed.

"Oh my god, Athena, I hate this song," says Sarah.

"I know," replies Athena.

Sarah and Athena met when their moms were in a support group for difficult toddlers. While Sarah grew out of that phase, Athena did not.

Even in the company of her only friend, Athena can't always restrain herself. Athena tells of a recent argument. "You were on the computer, and you were online," says Athena, "and I'm like, 'Sarah, can I go on?' And you said, 'In a minute.' And it was a minute for like, half an hour. I was mad, but I was laughing at the same time. I just shoved her so hard, and she went right into the wall."

"I don't know, I just smacked against the wall," says Sarah. "It hurt for a few seconds, but after that it was fine."

Sarah says she knows Athena can't always control her behavior. And mostly, they get along fine, like this afternoon when they decide to sell chocolate bars to raise money for a local charity. They walk door-to-door through the rows of mobile homes in Athena's neighborhood.

But Athena has few after school options. She was kicked out of the local Boys and Girls Club, and even her beloved cheerleading squad, for fighting with kids and coaches. Her mother Mary, who doesn't work, says she can't afford private after school programs.

"She's really not doing anything but coming home after school," says Mary. "If she happens to have a friend that particular day, she may have someone come over for a little while, but friendships are up and down from day to day."

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