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Shadow Syndromes

By John J. Ratey and Catherine Johnson

Shadow Syndromes.gifShadow Syndromes analyzes how subtle disorders can derail "normal" people.

389 pages
Pantheon (1997)

Reviewed by: Henry A. Pattiz
In describing how strange, dysfunctional behaviors arise and explaining how to deal with them, Shadow Syndromes gives a road map of psychological reactions that is useful for nearly everyone, including attorneys. What, for example, should attorneys do when they or their clients are so stressed by the legal process that they begin to exhibit strange behaviors? Authors John J. Ratey and Catherine Johnson have the answers. Not only is Shadow Syndromes a book to enjoy reading and sharing with others, it also is good science, and it tells how to anticipate stress reactions and what to do when they occur.

To respond to the behaviors of overstressed people in a way that does not increase their stress is not simple; it takes practice and time to learn how to see problems looming in interpersonal relationships. This book can lead readers through the maze.

In readable, accessible language, Ratey and Johnson outline a revolutionary view that most "mental" dysfunctions are based on brain configurations and chemistry that arise—most often in early childhood—from a number of factors, including genes and environment. Most people successfully deal with such problems in one way or another so that they find ways to live normally. For an unfortunate few, the dysfunctions are not handled, and shadow syndromes rise to the level of a clinical diagnosis. However, even those who learn to cope (for example, I am dyslexic and was labeled "slow" when I was growing up) do not entirely free themselves from shadow syndromes. They reside within the brain, waiting until the stress of life rises to a level at which "brain noise" (akin to static on a radio) "jams" the higher reasoning areas in the mind. When the higher reasoning areas are blocked, the shadow syndromes reassert themselves, sometimes dramatically, and may destroy interpersonal relationships of all kinds. People may recognize the shadow syndromes in themselves and others. They may say that they are going through a period in which "something is wrong" or say, "This just isn't me."

Shadow Syndromes uses the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a starting point to allow the reader to identify symptoms of more serious mental disorders. The DSM is used by mental health practitioners to categorize serious syndromes that require professional medical and psychiatric attention. But for persons with some of the symptoms, for whom direct professional mental health intervention is not appropriate, Shadow Syndromes offers an alternative. Mental health diagnosis has always been a matter of degree. If the degree of personal dysfunction is not great enough to require intervention, the afflicted person is often out of luck, especially if the individual has medical coverage through an HMO or a similar managed health care organization.

Shadow Syndromes indicates that, for the troubled person, feelings of unease and dysfunction may need some attention. Problems may even need medical treatment (for example, prescriptions) to treat the symptoms. Ratey and Johnson believe that many otherwise successful people with some shadow syndromes may needlessly suffer real pain (including sympathetic physical conditions) if symptoms are not properly diagnosed (in psychology, diagnosis is necessarily somewhat subjective), acknowledged (denial can be strong), and dealt with.

A practicing lawyer often may see such patterns—including irrational, depressive, manic, or obsessive behavior—in others. The term "burnout" frequently is used to describe the abnormal conduct of an attorney; "crazy client"is a not uncommon phrase for someone who has sought legal help but has not acted "reasonably." Shadow Syndromes shows how to spot such problems early, how to cope with them, and, implicitly, even how to exploit the irrational episodes of one's opponents.

For example, an attorney may have a levelheaded, reasonable client, with whom the attorney has worked successfully over a long time, who suddenly and unexpectedly becomes irrational or childish for no apparent reason. Or there may be a trigger, such as threatened litigation or a divorce, but the cause does not fully explain the difficult or even bizarre behaviors. The attorney may grow angry because normal efforts and means to communicate no longer apply. This book shows what likely has happened in such situations. The client has confronted unexpected stress, perhaps something personally embarrassing or even shameful, and has suddenly "lost it."The client cannot stop the stress and, at least for a time, cannot even explain what is happening, and is likely even ashamed of his or her uncharacteristic reactions, which further alienates the client from the attorney, who only wants to help.

The advice is to relax and defuse the stress if possible, to give the client patience and time, and not to increase the client's stress by becoming accusatory. What is happening to the client, and as a result to those around the client, is really not the client's fault. Shadow Syndromes indicates that recovery from shadow syndromes cannot be accomplished by thinking one's way through—at least not quickly. If the lawyer acts precipitously because of time pressures and stress (and is not law a stressful profession?), the lawyer will likely make matters worse and may lose the client.

Knowledge is the first step toward finding a solution. For example, people may be highly successful in their professional fields but nonetheless unhappy in their personal lives, perhaps because of an inability to find peace and partnership. Such problems, called subsyndromal syndromes, were the genesis for Shadow Syndromes.

Subsyndromal syndromes can include areas of dysfunction that are traditionally thought of as too severe to allow a sufferer a normal life—for example autism. Ratey and Johnson recount the troubled marriage of Dan, a computer wizard whose mild autism was not diagnosed until middle age, when his wife, deeply concerned with his behaviors, initiated therapy. The authors recount the fascinating story of how Dan's condition has affected him and those around him, pointing out that even autism is not all bad: for example, those who have it are generally incapable of deceit or bigotry.

The authors’ decision to begin their book with their personal stories is especially pleasing. (Readers also should not miss the authors' acknowledgments, which appear at the end of the book.) These revelations make the research and results compiled in Shadow Syndromes even more compelling and meaningful. The most general chapters, which apply to all the issues and syndromes in the book, are chapter 1, "The Noisy Brain," and chapter 8, "The Care and Feeding of the Brain." Chapters 2 through 7 form the core of the book, spelling out the characteristics of the various disorders. Chapters 1 and 8 may be read first, and then the others may be scanned to find the kinds of specific syndromes that are of primary concern. Many of the chapters contain counterintuitive information. Readers may discover that behaviors they considered as belonging to one shadow syndrome in fact belong to another.

Chapter 1 highlights how various coping mechanisms allow people to overcome, or successfully conceal, what may be considered abnormalities. The authors emphasize the dominance of brain biology—the chemical and physical elements of the mind. To some this emphasis on the chemical aspects of the brain may prove distasteful. The authors believe, for example, that many drugs are useful for correcting brain disorders, but they are equally sensitive to the need for counseling to help the afflicted individual to understand his or her condition and to take steps to restore balance. The authors also, in chapter 8, recommend concrete steps that those who are subject to large doses of stress may take to bring balance to their lives, including diet and, especially, exercise.

The authors detail particular syndromes, and anecdotes reinforce the clinical descriptions. Depression; manic depression (also known as bipolar personality disorder); intermittent rage; attention deficit and hypertension disorders; autism and its lesser symptomatic problems; and obsessive-compulsive, addictive, and anxiety disorders are all covered. All syndromes (which may be intermingled in one person) share the common effect of an inability to maintain open and socially effective communication with others. Some syndromes are relatively easy to meliorate, often by chemical treatments. Prozac or other antidepressants counter depression symptoms, and Ritalin and other stimulants work well for rage disorders and for attention deficit disorder. Other disorders, such as autism, have not yet proved treatable by any drug therapy. But even for those that are most difficult to resolve, knowledge of the symptoms and guilt-free recognition of brain function can serve to allow for better behavior modification and to permit the syndrome sufferer to work to establish better communication with his or her family, friends, and therapists.

It can be frustrating, even enraging, to confront a person with whom one cannot effectively communicate or reach. This brilliant book shows how to defuse frustrations when dealing with an uncommunicative or irrational person. With the understanding gained from this book, the stress involved in a difficult interpersonal relationship of any type, including a professional relationship, may be effectively diminished, rather than increased. Additionally, this book can help a lawyer "read" an adversary.

Shadow Syndromes is persuasive. Its readers may learn to enjoy work more—even the practice of law.

Henry A. Pattiz is a Beverly Hills attorney practicing in the areas of tax, insurance, real estate, banking, and corporations and business law.