Welcome to Max’s World

Amy is still figuring out how best to discipline her son. He needs boundaries, but she admits she's a sucker. She used to reward his good behavior with toys, and it seemed to work until she realized it was bribery and also that it was about to bankrupt her. "I started to feel like I had a Toys 'R' Us annex in my house," she says. So, with Ablon's guidance, she is trying to learn a new way to raise Max, using techniques outlined in the book "Treating Explosive Kids." Richie hasn't read the book. He has too much Marine in him to apply its methods, which focus on the child's concerns and discourage parents from imposing their will. When he was growing up, he says, a kid like Max would have gotten "smacked around a little. Not everybody was touchy-feely and politically correct." He admits he sometimes eggs Max on. "I'm trying to teach him in my own way," he says. It has been tough for Richie to accept that his son is not like other people's sons. "When I was Max's age, I was playing hockey and baseball. I was athletic," he says. "Max is 10 years old and he can't ride a bicycle, and that bums me out. He can't do a lot of things kids his age can do. But maybe as he gets older—you know, Tom Brady didn't start playing football until he was 12. There's still hope."

Richie comes from a long line of stoics. There is mental illness in his family tree, but it is not discussed. His brother took his own life at 21; no one knows why. "My father's not going to talk to me about it," says Richie, "because that's the way he is—he doesn't talk about anything." Like his father, Richie is no fan of talking. He also wrestles with some of the same issues as his son: he has a temper, and Amy calls him "inflexible." Richie counters that he's "stern, and she's Caspar Milquetoast." He says he has never been to therapy. But late last year, Amy demanded that the two of them see a marriage counselor. Richie agreed. They went a few times, but there were "scheduling issues," says Richie, and they haven't gone back. For the moment, they are getting help from the same people who help Max. Anything that makes his life easier makes theirs easier, too.

Max's life, of course, is rarely easy. During a recent appointment at Frazier's office, he went into full-fledged mania. Laughing wildly, he rolled on the floor, then crawled over to his parents and grabbed an empty medication bottle, yelling, "Drugs! I've got drugs! It's child safety!" Richie grabbed it back, Max screamed, Richie threw the bottle across the room, as if playing fetch. Max squealed and dove for it, then began to sing into the neck of the bottle: "Booorn to be wiiiiild …" Amy rolled her eyes: "Two kids." And then: "It's hard not to laugh."

It was. And it was hard to look at Max, who has borne so much, and remember that the grin on his face was not a sign of childish goofiness but a symptom of an illness. Sadness and anger can be pathological; anyone can see that. It's harder to see happiness that way. As Amy guided Max out of the office, she asked him if he was OK. Max cocked his head. It took him a few seconds to come up with his answer: "Apparently, yes." On this rare occasion, he'd described himself perfectly.

Max will never truly be OK. In a few years, he will hit puberty, and at that point things will get even more complicated. Teenage rebellion is one thing; a bipolar teenager's rebellion can end in tragedy. "What happens the first time he says to me, 'I'm not taking my pills'?" says Amy. "I can't put them down his throat." She also worries about the end of 10th grade, which is as far as the Manville School goes. Amy doesn't think Max will go back to public school in Peabody, which means he'll have to find another special school or he'll never go to college. Max hasn't processed that yet; he wants to be an animator and has already set his sights on the Massachusetts College of Art and Design. Amy hasn't really processed it either. Every year she puts money in a college account, although she knows the money almost certainly won't be used for tuition. "I want to believe that Max will have this great normal life, but I don't know what's going to happen," she says. "I wouldn't be able to get up in the morning if I thought about it. So I don't anymore."

There are scientists who have thought about the future of children like Max in great depth. Many still think bipolar disorder is vastly overdiagnosed, but they agree that those who have it face a long, rough road. Two years ago the NIMH released findings from a large study of kids diagnosed between 7 and 17. The ones who fared badly had an early onset of the disorder, as well as psychosis, anxiety, ADHD and a tendency to switch quickly between mania and depression. Max has all these. His chances do not look good.