Welcome to Max’s World

Even at home, Amy and Richie weren't safe from judgment. At their most strained, they turned on each other. Richie had been a patient person before Max came along, but now his patience was worn "as thin as a sheet of paper." Bipolar disorder runs strongly in families, so in the heat of their arguments, Amy and Richie both yelled the worst thing they could think of: "He's your kid! It's your fault!"

The Blakes had always planned on having another child. During the times when Max was stable—and there were some—Amy found herself thinking about that second baby. She and Richie feared their own genes now, but maybe they could adopt. She started looking at agencies. The next day, Max threw a tantrum, as if to announce that he knew what she was up to. That was when the Blakes decided their first child would be their last. Later, Max started to ask why he didn't have any siblings. At times, Amy said she didn't want him to have to share his toys, or that "Mommy and Daddy wanted one perfect child, and we got him." There were other times when her patience, like Richie's, was thin, and she felt that Max was sturdy enough to take a joke. Those were the times when she answered his question. "Look in the mirror," she'd say, half-smiling. "That's why."

By 7½, Max was on so many different drugs that Frazier and his parents could no longer tell if they were helping or hurting him. He was suffering from tics, blinking his eyes, clearing his throat and "pulling his clothes like he wanted to get out of his skin," says Richie. In February 2005, under Frazier's supervision, the Blakes took Max off all his meds. With the chemicals out of his system, Max was not the same child he had been at 2. He was worse. Bipolar disorder often gets more serious with age. The brain also reacts to some drugs by remodeling itself, and its dopamine receptors end up naked and sensitive. When the drugs are removed, it's a shock. Off his meds, Max became delusional and paranoid. He imagined Amy was poisoning him and refused to eat anything she cooked. He talked about death constantly and slept little more than two hours a night. Within a month Frazier had put him back on medication, but with a caveat: she wanted to place him in a short-term bed in a child psych ward.

This move did not sit well with the Blakes. They visited Max every day in the hospital but were disturbed to find that many parents with kids on the ward didn't do likewise. They also worried that Max wasn't getting proper treatment. Doctors couldn't check his med levels because he wouldn't sit still for blood tests. Finally, after three weeks, Amy and Richie held him down, and the resulting test showed his levels of lithium were indeed too low to do any good. Against Frazier's advice, they pulled Max out of the hospital and vowed never to send him away again. Two months later he jumped out his bedroom window.

Today, Max's med log is jammed full of papers: prescription sheets, printouts from Web sites, business cards from doctors. At 10, he has been on 38 different psychoactive drugs. The meds have serious side effects. They have made Max gain weight, and because he's still growing, they frequently need to be changed. The Blakes are aware that many people think their child—any child—should not be on so many drugs. They aren't always happy about it either. But to some degree, they have made their peace with medication.

Max's prognosis has also grown more complex in the seven and a half years since Jankowski first labeled him as bipolar and hyperactive. "He's oppositional defiant, he's dyslexic, he's ADHD, he's OCD," says Amy. "Give me an initial and he has it." Bipolar children, especially those diagnosed early, often have such a litany of disorders. The bipolar brain tries to compensate for its weak prefrontal cortex by roping in other areas to help; these areas may now become dysfunctional, too. Child psychiatrists thus face an enormous practical challenge: they often can't treat one disorder without affecting another one. "It's like a balloon where you push on one side and the other side pops out," says Wozniak, the MGH psychiatrist who helped define childhood bipolar disorder. With kids like Max, she adds, parents often have to settle for "just having one part of the symptoms reduced."