CNNHealth’s mental health expert, Charles Raison, MD, has posted something verging on an apology for an earlier question and answer post where he advised the mother of a child diagnosed with bipolar disorder that her child’s problems might not be due to the disorder, but to problems at home.
    
Raison, an assistant professor of psychiatry at Emory University in Atlanta, writes that he received a “spate of criticism” on the earlier posting, at least two of which came from prominent groups that advocate for children with mental illness.

In his earlier post, Raison wrote, “Children are often canaries in the coal mine of family conflict…. I can’t tell you the number of times I’ve seen a child saddled with a psychiatric diagnosis when the real problem lay with the mother and father, or some other component of the larger family system.”

Raison expanded on this argument, writing, “Sometimes when I’ve done family therapy in such circumstances, I end up with a strong conviction that the identified patient is in fact the sanest member of the family system, which is why he or she is having so much trouble coping. I am not saying that this is your situation, but given your description of the problem, you would do well to consider this possibility.”

This advice nettled Susan Resko, from the Child & Adolescent Bipolar Foundation, who responded in a letter to Raison, saying, “Your response to the poor mother harkens back to the days when doctors and society used to blame the mother for a child’s psychopathology…. Why do you draw mothers of bipolar children back to the Middle Age of child psychiatry? Please clarify your statement to the poor reader that you did not intend to fall into the old blame-the-mom routine.”

Raison’s earlier post also brought down some condemnation from Ken Duckworth, MD, the medical director of the National Alliance on Mental Illness.

In his most recent post, Raison defends how he answered the mom of the bipolar kid, saying that only a thorough analysis could really turn up the answer to why the child behaved well in school, but acted up at home. Raison maintains that his earlier advice might be valid, but he also acknowledged that the child might, in fact, be struggling as a result of bipolar disorder. Moreover, Raison concedes that if families, schools and medical providers fail to adequately assess such problems—and instead reflexively blame the parents for the behavioral issue—the results can be severe.

“Fobbing off disease-driven behavioral pathology on the possible shortcomings of family and friends can be a catastrophic mistake, both because it delays appropriate medication management and because of the psychological damage it inflicts on those in the shadow of a loved one’s mental illness,” he concludes.