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To Forgive and Discredit: Bipolar Identities and Medicated Selves Among Female Youth in Residential Treatment

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Abstract

Based on 11 months of ethnographic fieldwork at a residential treatment center in the United States, this article explores the varied meanings that female youth attribute to behavior and the strategic (mis)use of knowledge about psychiatric diagnosis and medication at a time when the scope of behaviors pathologized in young people continues to expand. Drawing upon psychological and critically applied medical anthropology, as well as contributions from philosophy on how classifications of people come into being and circulate, attention is paid to the multiple contradictions at work in diagnosing young people with mental disorders. A detailed examination of an exchange that occurred during one particular group therapy session is presented to demonstrate how psychiatric selves emerge in this environment when conventional labeling practices no longer suffice as an explanation of behavior. This turn to psychiatry reveals both the salience of and confusion around mental health treatment and diagnosis among adolescents, opens up the distinctions young people make between “real selves” and “medicated selves,” and invokes the possibility of psychiatric disorder as a means to both forgive and discredit.

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Notes

  1. The American Psychiatric Association published the DSM-5 in 2013, after the data were collected for this study. The youth described in this article who have been given psychiatric diagnoses would have been diagnosed according to DSM-IV-TR criteria.

  2. It is worth noting, however, that the controversy did influence revisions to the DSM-5 such that a new diagnosis was introduced—Disruptive Mood Dysregulation Disorder—“in order to address concerns about the potential for the over diagnosis of and treatment for bipolar disorder in children” (American Psychiatric Association 2013). Also relevant here is the undisclosed pharmaceutical industry support in the field of psychiatry and the extent to which such support biases diagnostic and treatment guidelines (Cosgrove et al. 2009).

  3. The total number of visits resulting in psychotropic prescriptions for this age group increased nearly twofold (191.7 %) over 7 years. In comparison, the number of visits that resulted in a prescription for a non-psychotropic medication increased by only 6.2 % (Thomas et al. 2006, p. 65).

  4. Vorrath and Brendtro admit that PPC owes much of its conceptual base to the GGI processes developed in the 1960s but maintain that there are useful distinctions between the two models. They argue that the PPC treatment philosophy is centrally about changing attitudes, values, and self-concept, whereas GGI is more focused on establishing self control over behavior (2007, p. 154). Based on my own review of the literature, I am not convinced that these distinctions are valid in practice. Furthermore, GGI at the Edgewood campus follows the same format as the PPC model. Thus, I treat the two models as interchangeable here. This approach has been used by others evaluating and reviewing peer interventions (see, for example, Brendtro and Ness 1982, and Elias 1980).

  5. It is notable that for a program based on creating a “positive” peer culture, there are no “positive” labels from which to draw in GGI.

  6. Depakote (generic: divalproex sodium) is an anticonvulsant medication used in the treatment of seizures, as well as in the treatment of acute mania associated with Bipolar Disorder. It is also used off-label for other conditions, particularly for other psychiatric conditions (such as Attention Deficit Hyperactivity Disorder). Drowsiness is a noted side effect of the medication (PubMed Health 2011).

  7. Trazodone is an antidepressant that belongs to a class of antidepressants known as SARIs (serotonin antagonist and reuptake inhibitors). Concerta (generic: methylphenidate) is a central nervous system stimulant used to treat Attention Deficit Hyperactivity Disorder. Seroquel (generic: quetiapine), Abilify (generic: aripiprazole) and Risperdal (generic: risperidone) are all atypical antipsychotics, also known as second-generation antipsychotics, because they are significantly different in structure and pharmacology from older antipsychotics such as Thorazine (generic: chlorpromazine) and Haldol (generic: haloperidol).

  8. Side effects clearly vary by type of medication. The chief complaints that I heard from residents—regardless of the medication they were taking—included drowsiness, dry mouth, and weight gain. The issue of weight gain for female adolescents taking psychotropic medications deserves further exploration, given that self-image at this age is so central. McCloughen and Foster’s (2011) review of literature on the impact of psychotropic-induced weight gain describes several studies that have linked negative self-image and low medication adherence to weight gain in adult populations but note the relative lack of literature on adolescents (Pogge et al. 2005 is an exception). Although compliance is not the focus of this study, it is worth highlighting that some youth are quite distressed by the side effects they experience and may request a medication change or stop taking medications altogether as a result.

  9. Research on the differential effects of psychotherapy and medication is growing but difficult to cover comprehensively because of the various types of psychotherapy (cognitive, behavioral, psychodynamic, interpersonal, etc.), the multiple medications available, and the different disorders being treated. Nonetheless, there is evidence that using psychotherapy and pharmacotherapy in conjunction may provide better outcomes that either modality alone (Gabbard 2006).

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Acknowledgments

This study was generously funded by the Wenner Gren Foundation (Grant #8116) and the National Science Foundation (Index #513127). I would like to thank the residents, staff, and administrators of Edgewood, who so graciously allowed me to conduct research on the campus where they live and work and who so openly shared their experiences with me. I am grateful to Kim Hopper for insightful feedback on earlier drafts of this article, and to Charles Harrington and Lesley Sharp for their guidance during data collection and analysis.

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    Leah Gogel Pope

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Pope, L.G. To Forgive and Discredit: Bipolar Identities and Medicated Selves Among Female Youth in Residential Treatment. Cult Med Psychiatry 39, 505–531 (2015). https://doi.org/10.1007/s11013-015-9426-y

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