Is Weiner manic, and does it matter?

Everyone who watches television or reads the newspaper knows who Anthony Weiner is. Most of the interest appears to be with his "sexting." When the coverage shifts from his inappropriate behavior to Weiner himself, the focus appears to be on his "narcissistic personality" or on his "sex addiction" for which he went to "rehab" without much apparent benefit.

Before I launch into any discussion of Weiner I must acknowledge that I have never met the man. Consequently, anything I say must be viewed as speculation and not based on any clinical, professional evaluation of the man himself.

So why not just keep my thoughts to myself? Two reasons, the less important of which is Weiner. If Weiner is indeed manic and had he accepted that reality and received the proper treatment, he might be well on his way to being our first acknowledged bipolar mayor of New York. The more important reason is that mania is a treatable disease when properly diagnosed.

There are millions of untreated Anthony Wieners in the United States who at this very moment are wreaking havoc on themselves and their loved ones while operating in a state of total denial.

As a psychiatrist, I have wondered why Weiner did not go directly to a psychiatric hospital where he would have been evaluated for a manic-depressive disorder and treated with a medication which would have taken the edge off of his hyper-aggressive, hypersexual behavior.

But then in America it is still preferable to be a "sex addict" than to have a bipolar disorder.

As a psychiatrist, I have wondered why Weiner did not go directly to a psychiatric hospital where he would have been evaluated for a manic-depressive disorder and treated with a medication which would have taken the edge off of his hyper-aggressive, hypersexual behavior.

But then in America it is still preferable to be a "sex addict" than to have a bipolar disorder.

Of course Weiner himself has never suggested he might have a mood disorder. It is important to realize, however, that most people who are manic deny that there is anything wrong with them.

First, because of the stigma still attached to the diagnosis and second because they enjoy many aspects of their mania ... at least until the situation implodes.

Like many people who are manic or otherwise intoxicated, Weiner has undoubtedly found the experience exciting, exhilarating and perhaps even addictive. Hence, his difficulty in stopping or even curtailing his behavior.

One of the traits of mania is an extraordinary insensitivity to one's effect on others. As people who are depressed tend to have low self-esteem and a hypersensitivity to the reactions of others ... people who are manic have an inflated sense of their own value and may be blindly insensitive to their impact on others.

Weiner is defiant in the face of people asking him to drop out of the race for mayor. He is rude, abrasive, irritable and irritating. He wishes to portray himself as strong and determined, like his ad campaign which says "Quitting isn't the way we roll in New York City. We fight through tough things. We're a tough city." One might reasonably ask: Is Weiner's reckless unwillingness to take no for an answer a sign of courage and determination or evidence of a blind insensitivity driven by a mood disorder?

Before we write off mania as invariably detrimental, it should be said that certain aspects of the manic personality such as drive, ambition, energy, enthusiasm, self-confidence, creative vision, verbal facility, the enjoyment of interacting with others, performing in public, etc. ... can be positive attributes especially in professions such as politics or the performing arts. But these gifts clearly may come at a high price.

There is a medical solution to the problem of mania. The first step is the recognition that this driven behavior, which may be highly pleasurable but very self-destructive, is a symptom of a medical disease. This diagnosis is very difficult for people with mania to hear and accept. It is even harder to accept the necessity of taking appropriate medication needed to modify those centers in the brain which drive this affect and behavior.

In the end, Anthony Weiner is just one person and he has had his "15 minutes of fame." What is more important are the millions of currently undiagnosed manic individuals in our country. They need to have the courage to look at themselves realistically and to honestly evaluate whether they may or may not be manic. Furthermore, if they conclude that this might be a possibility they need to have the wisdom and humility to seek a professional opinion and then attend a pro-bono Depression and Bipolar Support Alliance support group in their community. These are groups composed of wise and caring fellow travelers -- people who themselves have suffered with bipolar illness. There are 1,000 such groups in the 50 states. We are fortunate to have one of these groups in Greenwich. For more details, visit www.dbsagreenwichct.com.

Dr. John S. Tamerin, lives and practices psychiatry in Greenwich. He is a Clinical Associate Professor of Psychiatry at the Cornell/Weill School of Medicine and a member of the Board of Scholars of the Vail Leadership Institute