The Bi-Polar Puzzle

This fascinating article begs the question, what happens to those kids and families who don't have the resources to diagnose and treat their kids? Where do those kids end up? I assume that we see a large percentage that drop into the criminal justice system.

By JENNIFER EGAN

When Claire, a pixie-faced 6-year-old in a school uniform, heard her older brother, James, enter the family’s Manhattan apartment, she shut her bedroom door and began barricading it so swiftly and methodically that at first I didn’t understand what she was doing. She slid a basket of toys in front of the closed door, then added a wagon and a stroller laden with dolls. She hugged a small stuffed Pegasus to her chest. “Pega always protects me,” she said softly. “Pega, guard the door.”

James, then 10, had been given a diagnosis of bipolar disorder two years earlier. He was attending a therapeutic day school in another borough and riding more than an hour each way on a school bus, so he came home after Claire. Until James’s arrival that April afternoon, Claire was showing me sketches she had drawn of her Uglydolls and chatting about the Web site JibJab, where she likes to watch goofy videos. At the sound of James’s footsteps outside her bedroom door, she flattened herself behind the barricade. There was a sharp knock. After a few seconds, James’s angry, wounded voice barked, “Forget it,” and the steps retreated.

“If it’s my brother, I don’t open it,” Claire said. “I don’t care if I’m being mean. . . . I never trust him. James always jumps out and scares me. He surprises me in a bad way.”

I left Claire’s bedroom and found James with his mother, Mary, in their spacious living room, which has a sidelong view of the Hudson River. James is a fair, athletic-looking boy with a commanding voice and a restless, edgy gait. He began reading aloud a story he wrote at school called “The Mystery of My Little Sister.” It involved James discovering Claire almost dead, rescuing her and forming a detective agency to track down her assailant. He read haltingly, often interrupting himself. When his mother asked a question, the roil of frustration that nearly always seethes just under James’s surface, even when he is happy, sloshed over.

“If you listened on the first page, it says it!” he scolded her, then collapsed hopelessly beside the coffee table. “You don’t get anything. Now I lost my place. Forget it. I give up.” He crossed his arms on the table and rested his head in them. Mary waited quietly in her chair. Sure enough, a minute or two later James began reading us a list he had concocted of 50 ways to get rich. The next time his mother spoke, he bellowed: “I wasn’t talking to you! I’m not reading it now!” He threw the paper down and stalked out of the room.

The baby-sitter arrived, a 27-year-old preschool teacher whom Mary hired to come in a few hours each week and help maintain harmony when both her children were home. It wasn’t easy. There was a basic rhythmic pattern to the afternoon: James reached out, craving attention and engagement, then stormed away in roaring frustration only to return, penitent and eager to connect, cuddling and hanging on to his mother in a way unusual for a boy his age.

NY Times