March 3, 2008 -- During a meeting at work -- especially a long meeting -- it can be tempting to play the psychiatrist. Look around the room and think to yourself, "My boss must be obsessive-compulsive." "Our receptionist has ADHD."
Yet chances are that someone in the company really does struggle with a mental disorder. And for 5.7 million American adults who have bipolar disorder, their illness can have serious ramifications for their careers.
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Bipolar disorder is characterized by episodes of extreme mood swings -- from euphoric or aggressive manic episodes to low-energy depressive states.
People with the disorder often have trouble keeping a job and are 40 percent less likely to be employed than the average person, said Ronald Kessler, a public health researcher at Harvard University.
On the other hand, Kessler said, if treated properly, they can be creative and invaluable individuals. Many highly successful authors, artists and professionals have the disorder.
But coming forward with this information can be a risky career move. While it could help others understand their struggle, it can put their employment in jeopardy. Even worse, for many the fear of being "found out" could affect their decision to seek appropriate treatment.
Steve, who asked that ABC News use his first name only, was diagnosed with bipolar disorder as a young teenager. For a decade, he worked as a financial adviser with several banks around Boston.
One day, he let it slip.
His wife had just dropped him off at work after an appointment, and when Steve tried to introduce her to a bank manager he worked with, he forgot the man's name.
"I just blurted it out. 'I'm sorry I'm getting shock treatments. I can't remember anything,'" Steve said. His colleagues' reactions were less than encouraging, he recalled.
"I would say that they were afraid of me," Steve said. "They stopped referring their clients to me."
Steve said that eventually his colleagues' attitudes forced him to leave his job.
Symptoms, Secrets and Stigma
People with bipolar disorder face a conundrum at work. If they disclose their condition, they may face damaging stigma like Steve did.
But it often helps to confide in close co-workers, as this could provide a support network. Colleagues "in the know" may even be able to help those with bipolar disorder monitor their moods.
The earlier you catch a relapse into a manic or depressive episode, the earlier it can be stopped, said Dr. Gary Sachs, director of the Bipolar Clinic and Research at Massachusetts General Hospital in Boston. But very often, people with the disorder have trouble recognizing that their behavior is becoming strange.
Co-workers and friends are often the first to see the signs. The most obvious indication of an oncoming episode is a change in personality.
For a depressive episode, a normally articulate person may not be unable to string together a sentence, said Sachs. He or she may move slowly, cry or otherwise appear very depressed.
For mania, the symptoms can be much more unnerving.
"Someone who's a middle-of-the-road person is suddenly much more animated -- perhaps also revealing more," said Sachs. "You may wonder why you had to know who they were with last night."
Subtle signs might include a change in style of clothing, makeup or the amount of jewelry a person wears.
These indications were precisely what Steve demonstrated before he lost his first job as a teaching fellow in psychology at the State University of New York at Stony Brook.
"I sort of reinvented myself," said Steve, who said he wore a "uniform" of jeans, flannel shirts and sneakers. "Then I had this complete and total desire to wear Hawaiian shirts, bell bottoms and platforms."
His students started noticing other signs of mania; he jumped from point to point in a lecture and got angry when others couldn't follow.
"Mania is by no means a euphoric state," said Steve. "Try disagreeing with me when I'm manic, and I'm evil; I become quite combative."
Later, when Steve ended up hospitalized with depression, he was surprised to find his co-workers -- specialists in the field of psychology -- shunned him.
"They had fixed boundaries between where they sat and where I was," said Steve. "They saw me, and they thought, 'If it can happen to him, it can happen to me, it can happen to anybody.'"
Steve eventually decided that he didn't have the stability to get through the Ph.D. program.
"There's still quite a bit of stigma in the public," said Sue Bergeson, CEO of the Depression and Bipolar Support Alliance. She herself has bipolar disorder.
In a 2004 poll, the DBSP found one out of five people believed that people with bipolar disorder were incapable of holding down jobs or keeping up personal relationships. One in six said they shouldn't have children, said Bergeson.
However, if treated, people with bipolar disorder may be quite functional. With long-term support, medication, therapy and a stable job, they may not have an episode for years, or even decades, said Sachs.
The challenge is to find and stick to treatment, which, said Bergeson, is made much more difficult by the stigma associated with the disorder.
Bergeson, now 50, kept up a successful career in nonprofit groups for years while keeping her disorder a secret. She paid out-of-pocket for treatment and medications, fearing that someone at work would find out about her condition through her insurance.
"I never told anyone," she said. "I just told my family, not even my friends. It was something I didn't want to talk about. I was ashamed."
That all changed when her sister, who also had bipolar disorder, committed suicide in 1999.
"I thought, 'Her life was very, very painful, and I need people to understand about these illnesses, and I need to rethink how private I've been," said Bergeson.
Ironically, Bergeson said, research shows the best way to reduce the stigma of mental illness is for people to learn that they know someone who has one.
"Another reason to talk about this in the workplace is to make sure mental health insurance is on par," said Bergeson, who said that her sister's insurance only covered 10 days in a hospital and 20 visits to a therapist for mental health -- not for a year, but 20 visits for her entire life.
"We lost our dear sister, and we are not staying quiet -- no way," said Bergeson.