2009 Casey Medal Winner, Magazine: “Growing Up Bipolar” (Q&A)

Newsweek reporter Mary Carmichael’s story about Max Blake, a 10-year-old boy with bipolar disorder, won a 2009 Casey Medal in the Magazine category. Carmichael talks with JCCF’s Michelle Parks about how she created her vivid, unblinking portrayal of Max and his family’s struggles.

How did you conceive the idea for the project?

At first, my editors and I were interested in childhood bipolar disorder simply because it's a controversial topic -- there's a lot of debate about how the disorder should be diagnosed and whether it even exists in kids. But then I found that most of what had already been written was focused on either the academic side of the controversy  -- [such as] what is the definition of pediatric bipolar disorder -- or the dangers of medicating kids. There weren't many vivid descriptions of the actual experience of being, or raising, a child with the diagnosis. So I decided I wanted to bridge that gap -- to show as well as tell, to force the reader to think through the difficult decisions that parents have to make instead of just saying "parents of these kids have to make tough decisions."

I thought the best way to do it would be to zoom in on one family, to give the reader someone with whom to identify. I knew the Blakes were the right family when Amy [Max’s mother] said to me in our first interview that "no one understands how it feels" to raise a child like Max -- after all, the whole purpose of the project was to show people how that feels.

What was the process you used to report this story?

I found the Blakes through Max's psychopharmacologist, Jean Frazier. I first met the family in December of 2007, at which point I conducted a rambling three-hour taped interview -- I sat down with Amy and said, "Tell me the whole story from the beginning." Then there was about a month of lag time while my editors and I thought about how we could turn that interview into a long-form narrative and what else we would need to fill it out. By late January, we had committed to the project, and I spent the next month doing more sit-downs with each of the Blakes and everyone else who figured in the story, such as Max's doctors and teachers. I also spent a lot of time looking at Max's medical records -- Amy had saved over 1,000 pages of them.

In March, I spent a week with the Blakes -- I slept over one night and was with them pretty much every day, following them to karate and horseback lessons and doctor's appointments. That happened to be the week that Max brought home the suicide note that I quoted in my lead.

After that week I sat down to write the story, and once I had a draft, I went back and confirmed every last detail with them in person. Then we edited the piece and I fact-checked it again. I wouldn't usually fact-check in person, but some of the details of this piece were painful, and I wanted to ask the questions as gently and humanely as possible.
 

How much research on bipolar disorder did you do?

I started out by reading books, but most of them were either how-to manuals for parents or polemics against medication, and I needed something more scientific than the first type and more neutral than the second. So I had to do a lot of research on my own. I called 15 or so scientists and doctors, some who strongly advocated the diagnosis and some who thought it was vastly over-applied; they all gave me long, thoughtful interviews and pointed me to the most important papers in the field. A lot of those people didn't make it into the final draft of the piece, but they helped me understand what might be going on in Max's head. That was especially important because Max, like a lot of kids, sometimes had trouble articulating exactly what it was he was feeling.

How much time did you spend with the Blakes?

All told, I probably spent about 80 hours with them, another 20 hours interviewing other people related to the story, maybe 15 hours examining medical records and 30 hours doing background research.

How long did it take to produce this story, from the initial idea to publication?

It took from December 2007 to May 2008, so about five months. The last month of that mostly involved waiting for a publication date -- to make the cover, we needed a week in which there wasn't a lot of big national news.
 

What challenges did you face along the way in this story?

This was a tricky story. I was largely writing about events I didn't witness (Max's first 10 years of life) and melding that reporting with events I did actually see (from the weeks I spent with the Blakes). This meant I had to be sure that what I printed about the past was as firmly verified as it could be, so that it had the same factual authority as the present-day stuff. It helped a lot that Amy had kept such extensive records, including medical documents, short diary entries and behavioral assessments from Max's schools. I also had to go back and try to interview everyone who was involved in the stories I was telling. Sometimes I couldn't get corroboration; for instance, Max's teachers from his preschool years didn't want to talk to me, so I had to write especially carefully about his experience in preschool.

I also worried about whether I was affecting Max's present-day behavior simply by being there to observe it. I tried to get around this by spending a lot of time with the Blakes without my notepad, just hanging out and watching cartoons or eating pizza so that Max could get used to my being around.

One problem I was expecting to run into -- and didn't -- was the prospect of the Blakes not telling me everything or editing their own accounts of things to make themselves look better. To their credit, not only were they never reluctant to talk, they actually volunteered a lot of extremely private details before I could ask about them. I think they had felt misunderstood and ignored for so long that they were eager to get everything out in public -- even the bad stuff.
 

What advice would you give other journalists who want to tackle this subject?

Two pieces of advice: One, trust your instincts. You probably know a good story when you hear one. We had no news hook for this piece, and we're a news magazine, so it was an unorthodox thing for us to run -- especially on the cover. But if a narrative is compelling enough, you don't need a news hook to justify publishing it. Piece of advice number two: At its best, medical writing isn't just a form of science writing. Science is about discovering things in the world. Medicine is about using those discoveries to help people. It's easy to forget about the people and focus on the science, but the science isn't what moves readers. So if you can, always put the people at the center of your story.
 

What did you learn about reporting on this topic that you could apply to your future work?

I learned a great deal about how little scientists actually know about the brain! One of the reasons the Blakes felt so helpless was that a lot of Max's doctors just couldn't give them concrete answers about what was going on in his head -- and this of course meant that their treatment regimens ended up being based at least part in trial-and-error. Amy and Richie desperately wanted their kid to feel better, and not only could they not help him, a lot of times the doctors couldn't either.

During the reporting process, I came to identify with their frustration in a small way, because I was calling the country's top experts on childhood bipolar disorder and they were giving me similarly incomplete information about it -- not because they were being evasive, but because they genuinely didn't have all the answers. With all the hype around neuroscience of the last 15 years or so, many of us have come to believe that psychiatrists know an enormous amount about the brain and how to make sure it's working properly, when in fact they've got a lot more to learn, particularly when it comes to children. That doesn't make them nefarious -- as they tend to be painted -- it just means they're not all-knowing. I'm sure that theme is going to inform what I write in the future about psychiatry and psychology.

What was the public response to this piece?

I got very few bad reactions to the piece itself (if you don't count the woman who insisted that I was making up the details because no one would ever let a reporter that deep into their personal lives). The Blakes themselves, however, did come in for some nasty comments. There were a lot of people who argued that Max didn't have a mental illness at all, or that he actually had fill-in-the-blank-disorder instead of bipolar -- people who armchair-diagnosed him without having met him. There were also some people who condemned the Blakes for medicating Max. I fully expected both of those criticisms. Unfortunately, you can't write a story about a family who feels persecuted by closed-minded people without provoking some of that closed-minded persecution.

On the plus side, there were many other people -- the majority, I'd say -- who were touched by Max's story and either offered support or tried to help, in sometimes bumbling but always well-meaning ways. And I think we reached a lot of people who didn't have any prior understanding of childhood bipolar disorder beyond the superficial awareness of the diagnostic controversy. I talked to Amy several times in the days following publication, and at first she was very hurt by the negative comments. Then a woman she vaguely knew called her and said, "Amy, I had no idea what you guys were going through. I'm so sorry. What can I do to help?" Amy told me that call outweighed all the criticism. That gave me chills. Making that human connection with a reader -- putting him in someone else's head for a while, making him understand things instead of just knowing them -- is, for me, the whole point of writing.