Welcome to Max’s World

Scientists now know that bipolar children have too much activity in a part of the brain called the amygdala, which regulates emotions, and not enough in the prefrontal cortex, the seat of rational thought. "They get so emotional that they can't think," says Mani Pavuluri, a child psychiatrist at the University of Illinois at Chicago. More than the rest of us, a bipolar child perceives the world as a dramatic and dangerous place. If he is shown a picture of a neutral face, he may see it as angry. Show him one that really is angry, and his prefrontal cortex will shut down while his amygdala lights up like a firecracker. The typical result: a fury that feeds on itself. Neurological research has its limits, though, and bipolar disorder still cannot be identified based on brain scans. Diagnosing it is more art than science. Many psychiatrists think that in the years since Max's diagnosis, doctors have erred on the side of seeing it everywhere, mislabeling kids and creating a lucrative market for drug companies. Even one of Max's docs says he thinks nine out of 10 kids with the bipolar label have been wrongly classified. But this sort of debate doesn't much interest Amy. "I don't care what diagnosis Max has," she says. "To me, the concern is, what are we going to do about it?"

In the months after his diagnosis, Max's med log filled up with drug after drug, but he didn't get any better. His private day care kicked him out at 28 months, and the Blakes transferred him to their best remaining option, a public-school special education program. Now he was surrounded by children with physical or serious learning disabilities, in the care of people who were neither trained nor able to handle such a small, angry bull. Amy would drop him off in the morning, only to arrive at her Boston office and find a message from a teacher telling her to drive back to Peabody and pick him up. There were whole months when he was suspended and the Blakes were stuck at home. Something had to change.

Amy had never stopped thinking about a second opinion. Through a friend, she heard of Jean Frazier, a child psychiatrist at McLean Hospital in Belmont, Mass., who was interested in behavioral therapies as well as drugs. On Dec. 19, 2000—a year, a month and a day after Max's first visit with Jankowski—the Blakes took their 3-year-old to Frazier's office. Max started off in good spirits, but as the appointment wore on, he began to fidget. He refused to look at Frazier when she asked him questions. He tried to bite Richie. He told Amy he wanted to go home. Instead, the Blakes stayed, and Frazier started asking questions again, this time in a whisper. Now Max paid attention, and Frazier realized something: he had been irritated by the sound of her voice. Max couldn't tolerate normal volumes of speech. In her notes, she wrote that he was "a handsome young man with dark hair and a twinkle in his eye." She agreed that he had classic symptoms of bipolar disorder, but she ordered a fresh round of brain scans and blood tests. She told the Blakes she wanted to streamline some of Max's meds. They asked about play therapy, which Jankowski had discouraged. She gave them a referral. More important, she gave them hope.

Max was still adrift in the public schools' special-ed program, and soon he would need to go to kindergarten. Under state and federal disability laws, the district had to pay for him to attend private school if it couldn't meet his needs. Hoping to keep Max in the public-school system, Peabody administrators designed a special curriculum for him. He lasted six weeks, punching and cursing and vandalizing the walls, before they gave up and agreed to send him to the Manville School, part of the Judge Baker Children's Center in Boston, at a cost of $64,000 a year. Manville looked like a regular school, with desks and chairs and a brightly colored mural in the lobby, but it was staffed by social workers and psychologists. It had three teachers for every eight students and almost as many timeout rooms as classrooms. Amy bought a huge three-ring binder where she kept every teacher's note about her son's school-day behavior, the way another mother might save book reports and drawings of dinosaurs. She also found a babysitter, Jenny Mellor, who could watch Max in the afternoons. Richie arranged to spend more time at home, too. He became a firefighter; he had to sleep at the firehouse two nights a week, but that meant he could spend the following days with his son.

For all the support he was getting, Max's life was still a series of upheavals. In the space of one year, he tried eight psychoactive medications. Despite all the meds—and in part, because of them—he was an emotional wreck. Amy learned to recognize a look in his eyes. When she saw it, she'd think, "Here comes the devil." In January 2002, 4-year-old Max said he wanted to "freeze to death." In June, he ran away; Amy found him hiding under a neighbor's car. Max seemed to think his imaginary friends were real. His parents wondered if he was hearing voices. In the grocery store, he heard a woman laughing in the next aisle and broke down—he thought she was laughing at him.

By now, Amy and Richie were feeling stranded. Max couldn't go to birthday parties, so Amy quietly tossed the invitations in the trash. Some of the Blakes' friends stopped calling. Amy's mother started e-mailing her "cures" for bipolar disorder she'd found on the Web. Amy wondered if Max's own relatives thought he was "damaged goods." Strangers were no more understanding. One afternoon at the mall, Max threw a fit, and a woman walked up to Amy and told her people like her shouldn't be allowed to have children.