Chapter 96. Types of Mood Disorders

Khalil is a 29-year-old mechanic. For several years, he owned and operated his own auto repair shop, but it turned into a financial disaster. About six months ago, he had to close the shop and take a temporary job as a janitor. He reports that he now feels like a failure and is ashamed to be seen in public. He has persistent feelings of worthlessness and inferiority, and doesn't see any hope for the future. He has broken off his engagement because of his financial problems and his pessimism about his future prospects.

However, he still frequently visits the home of his younger brother, and seems to be able to enjoy himself in the company of a small group of family members and friends who accept him. When he is alone, his feelings of failure well up inside him again. He reports that he spends most of his free time in his basement, cleaning his tools and staring aimlessly at the walls, and he sometimes thinks about ending his life so that he won’t bring further shame upon his family.

Dennis is 35 and currently unemployed. He had been a hyperactive child with a history of impulsive behavior in the classroom. After high school, he held a series of jobs selling cars, then insurance, and finally office furniture. In each of these jobs, he had some initial success (in one case, he was promoted twice in the first few months), which was followed by a period of erratic performance and eventual termination by his employers.

The pattern was always the same: Almost overnight, Dennis changed from a warm, personable salesman to a boisterous braggart who antagonized his customers and coworkers with loud, non-stop talking. He would go without sleep for days at a time, showing up at the office at all hours of the day or night, spending the company’s money on wild schemes and extra supplies to handle the anticipated "explosion" in sales (which never occurred). During these periods, Dennis’s family could do little to control his energy and irrational optimism. Typically, after a few weeks, Dennis’s energy suddenly evaporated, leaving him listless and apathetic, and unable to continue his job.

Cheryl is 42 years old and had been employed as a part-time accountant for the past ten years. Cheryl describes her childhood as unhappy, and says, "Things just got worse as I grew up." Until recently, Cheryl was able to function normally in her job and in her family responsibilities. But over the past year, her family has become very concerned about disturbances in her behavior. For at least a month, she has withdrawn from family life, staying in bed for days at a time, refusing to cook or eat or go to work.

She has lost weight and claims to have no energy or desire to do anything. She weeps frequently and for no apparent reason. She went through a similar episode about seven months ago, but she snapped out of it after a few weeks. Although her employer was supportive during that first episode, after several weeks of this latest display of erratic behavior, the company fired Cheryl. That was four days ago. She has not bathed since that time, and she rarely leaves her room or talks to family members. When she does, she walks and talks very slowly.