The Counselor's Counselor: Negotiating Highs and Lows

Even in law school, "Speed" McGee had a reputation for pushing himself to the limit, working two part-time jobs and pulling all-nighters until exhaustion or illness forced him to recuperate. "Mercurial" best describes this hardworking attorney, whose seemingly limitless energy propels him through the toughest cases until he falls, exhausted, into apathy.

When work.JPG (24536 bytes) he hits a low point, McGee can barely function and must force himself to get up every morning. Sometimes he even stays home in bed, sleeping and eating just enough to get his wife off his back. After a few days, his spirits slowly rise until he resumes a more optimistic and energetic outlook on life.

"He shouldn’t push himself so hard," his partner says. "He needs to learn how to pace himself."

"He just needs some down time to bounce back," his administrative assistant says.

"He needs to take longer vacations and spend more time with his family," his wife says.

But McGee’s up-and-down work style may reflect a more serious problem he can’t control without professional help. His behavior pattern indicates symptoms of a bipolar disorder. Once called "manic-depression" because of its alternating spells of over-activity and listlessness, this disorder affects about 1.6% (2 million) of the general population.

A cycling pattern of elevated and depressed moods characterizes bipolar disorder. It is usually diagnosed when the symptoms cause significant personal distress or interfere with work, family activities or relationships. In less extreme forms, the highs (hypomanic episodes) are not necessarily bad, because they make you feel good and can result in super-productivity. But at what cost?

Whenever McGee hits this stage, he believes he’s invincible, which his clients love. Still, his wife and co-workers notice obvious signs of increased talkativeness and distractibility, as well as changes in what and how he eats. And he thrives on little, if any, sleep.

In contrast, when McGee crashes from an emotional "high," those around him quickly pick up on his fatigue and lack of interest or pleasure in daily activities. He feels sad and worthless and can’t concentrate on anything for very long. He just wants to be alone. He may even think about death or suicide.

Typically, the people around McGee will be the first to notice that his erratic behavior is becoming a problem. This is especially true over time, because the alternating episodes of hypomania and depression may become more extreme or may occur closer together. His mood may shift, with little notice, from expansiveness into irritability.

As McGee’s hypomania escalates, he may begin to pursue risky yet pleasurable activities, such as going on a buying spree, being indiscreet sexually or engaging in a foolish business venture. He could even become delusional, markedly impairing his work and relationships.

Interestingly enough, at this stage McGee might deny having any psychological problems and refuse to "listen to reason." The best intervention may be a psychiatric evaluation of his physical and mental status, which can also determine whether his depressed moods are simply caused by an inactive thyroid.

Bipolar disorder has been linked to various causes: a biochemical imbalance, irregular hormone production and problems with neurotransmitters (the chemical connectors that communicate between nerve cells). Also at play may be an inherited vulnerability triggered by environmental stress.

If McGee does have a bipolar disorder, the good news is that effective treatments help most adults. To level out McGee’s moods and help him approach life and work more even-handedly, his doctor might prescribe a mood-stabilizing drug. With medication alone, about 30% of those with a first episode of bipolar disorder will experience complete remission. But even they will need to continue taking a prescribed drug for preventive maintenance. Going off medication is one of the main causes of relapse.

Psychotherapy combined with medication will help McGee manage his mood swings and improve communications and relations with family members and co-workers. He can learn how to recognize oncoming symptoms and can develop basic coping skills, such as eating right, exercising regularly and getting enough sleep. Participation in peer support groups can be helpful as well.

In most cases, attorneys like McGee respond well to treatment that levels out their moods. As a result, they can maintain not only their practice but also their quality of life.