56 REFLECTIONS ON CHARACTER AND LEADERSHIP
W h e n t h i n g s g e t s o b a d t h a t f r ie n d s , c o - workers, and family members
can no longer ignore the problem, those interested parties still have to
convince the hypomanic him - or herself of the need for change. At these
times it is often hard to convince them that some form of intervention
is needed. That task is further complicated when spontaneous remission
occurs (as is often the case). During remission, the severity and nature
of manic episodes is minimized or even forgotten, creating the illu-
sion — for victim and associates alike — that the problem is under control.
It is easy to underestimate the seriousness of the situation. People with
affective disorders — like hypomania — are far more likely to commit
suicide than individuals in any other psychiatric or medical risk group.Possible interventions
Let ’ s return to David Klein and think about what might be done to help
him. What are his options? What would be the appropriate form of
intervention? As we consider treating this disorder, we have to take
some things as givens. The origins of hypomanic behavior seem to be
physiological, tied to defects in the neurotransmitter system. Due to
some as - yet - unidentifi ed form of genetic vulnerability, these defects
render the system unable to dampen unwanted oscillations and provide
regulatory stability. In spite of the genetic underpinning, however, envi-
ronmental stressors also appear to play a role. Hypomania is a chronic
condition; it will not simply go away, even with treatment. As suggested
there seems to be a genetic basis to bipolar disorder, which has been
demonstrated through twin studies. Data from identical twins show that
if one twin is bipolar, it is very likely that the other, if not bipolar him -
or herself, will have a cyclothymic nature (Bertelsen, Harvald, and
Hauge, 1977 ).
Bipolar disorder is also relatively common. This is bad news, to be
sure, but there is good news to balance it: no other form of mental illness
has been more profoundly affected by advances in neurophysiological
research than bipolar disorders. Lithium and related drugs are highly
effective in controlling the devastating effects of this dysfunctional state ’ s
more serious forms, allowing people to lead relatively normal lives.
Many people have taken these medications with good results.- Is the person engaged in irrational fi nancial activities, including
massive overspending and unwise investments? - On ‘ down ’ days, does the person obsess over past actions, berat-
ing him - or herself unduly? - Does the person have a problem with drugs or alcohol?