Field Guide to the Hypomanic: Hothead of State

As Barack Obama's chief of staff, Rahm Emanuel is arguably the second most powerful man in America. It's a job tailor-made for the unflappable—but that's not a description anyone would ever apply to Emanuel, not even when he was a political rookie raising money for Chicago Mayor Richard Daley. If donors didn't agree to quintuple their normal contributions, Emanuel scolded them for their stinginess and hung up the phone. Obama senior adviser David Axelrod, who has known Emanuel for decades, contends the method displayed a level of chutzpah that "redefined the term." And it worked. Emanuel broke all fund-raising records.

Two things are absolutely clear about Rahm Emanuel. He is effective and he is extreme.

Emanuel says f*ck more frequently than "if, and, or but," insists political scientist Larry Sabato. Obama himself regularly jokes about Emanuel's profanity: "For Rahm, every day is a swearing-in ceremony." These days, Emanuel is making deliberate efforts to tone himself down. "I'm not yelling at people; I'm not jumping on tables [anymore]," he told Mark Leibovich of The New York Times.

Still, Emanuel displays many characteristics of a hypomanic temperament. This mildly manic disposition—which is not a mental illness—comes with assets that could propel someone to the top of his field: immense energy, drive, confidence, creativity, and infectious enthusiasm. I have found through interviews and historical accounts that hypomania has animated many leaders, from Alexander Hamilton and Andrew Carnegie to Emanuel's former boss Bill Clinton.

But it also carries a cluster of liabilities: overconfidence, irritability, and especially impulsivity that often pitches the hypomanic into hostility. Drives are heightened and impulse control is weakened, making the hypomanic brain like a Porsche with no brakes. In keeping with his hypomanic temperament, Emanuel doesn't need much sleep and he can't stay still. "He's like a shark that always has to keep moving or he dies," says John Lapp, who worked for Emanuel. And, like Clinton, Emanuel is highly creative, not least because his hyperkinetic mind can't stop generating ideas. "He's an idea machine," Sabato says.

While there are no strict estimates of the heritability of hypomania, it runs in families with bipolar disorder. In fact, Rahm Emanuel is one of three remarkably successful brothers who share many of the same traits. All three have risen to the heights of their professions—Hollywood, medicine, and politics. Ari, the youngest, is founder of the Endeavor talent agency, which represents many of Hollywood's biggest stars. He is the inspiration for Ari Gold, the lovable, fast-talking agent portrayed on HBO's Entourage. Zeke, the oldest, is head of bioethics at the National Institutes of Health. He currently works at the White House as a special adviser for health policy.

According to Chicago Tribune White House correspondent Naftali Bendavid, who tailed Rahm while chronicling the 2006 Congressional election in The Thumpin', Emanuel epitomizes "unyielding aggression in pursuit of his goal," but not impulsivity. Unlike Clinton, whose "purple fits" of rage were legendary, Emanuel never lost control despite running 435 Congressional races. Even when he got in people's faces, there was a clear purpose in grilling his staff, district by district, at staccato speed, making his displeasure known if anyone stumbled.

If you picture the id and ego as a horse and rider, Rahm has a gigantic horse—like other hypomanics. But he's also a highly skilled rider. He's more heat-seeking missile than loose cannon.

His personality owes as much to his upbringing as to his biological inheritance. To learn more about the Emanuel family, I interviewed Zeke. We met at a coffee shop across the street from the working entrance to the White House. He walked in briskly—tall, wiry, with salt and pepper hair. He didn't order coffee, didn't take off his coat off, just plopped down, smiled, and shrugged his shoulders, as if to say: Go. He wasn't unpleasant; there were just no pleasantries.

When I mentioned that he and his siblings have been called the "hyperkinetic Emanuel brothers," he laughed. "Yes, we're very active." He spent the next 35 minutes spinning the track ball on his Blackberry and reviewing his emails—while warmly engaged in our conversation. The Emanuel boys were so active from an early age that the family had to move from their second floor apartment because of the constant commotion.

The center of the Emanuel universe was the family dinner table, a boisterous place where all the meaningful issues of the day were hotly debated. While Rahm has called the verbal combat that took place there "gladiatorial," Zeke described it to me as more of a Talmudic debate—the Jewish tradition of argument where one's opponent is viewed as an ally in the search for truth. "It's a sign of love to take someone's view seriously," says Zeke, who has fostered at NIH a style modeled directly on the Emanuel dinner table; he calls it "combative collegiality."

The most important measure of mental health, psychoanalyst Melanie Klein believed, is a capacity to integrate caring and aggressive feelings in relationships. In that regard, the Emanuels grew up extremely healthy. While a great deal of aggression was tolerated and sparked "a lot of competition, a lot of bloodshed, and plenty of fights between the brothers," it was also tempered by the underlying warmth. The warmth factor not only counterbalanced the aggression—this was not The Sopranos—it reduced the hostility that so often accompanies hypomania.

Their father, Benjamin, a physician, set the tone. "What are you, an idiot?" was a typical start to a sentence. I got a small taste of Benjamin's biting humor when I called him to find out what it was like raising three remarkable sons. "What was it like? It was miserable," he joked (I think) in a deep Israeli accent.

The hypomanic temperament, like manic depression itself, is unusually common among immigrants. It's their restless ambition that makes them get up and go to a new place—which is why hypomania fuels the American temperament in general, as well as the innovation that has made America an entrepreneurial haven.

Behind the boys' exuberance were two strongly supportive—and highly active—parents ready to encourage the creativity of their sons' bursting minds despite their modest means. "No harebrained idea went unsupported," Zeke told me, "and we had lots of ideas." When the boys wanted to build a computer, the parents helped them rummage for parts.

Hypomania often drives people to challenge authority, and just about everyone on the Emanuel family tree has been a rebel with a cause, suggesting that Rahm was almost destined to lead a charge on some front. Benjamin worked as a medic for the militant Zionist Irgun during the 1948 Israeli war for independence. When he came to America, the immigrant pediatrician campaigned against the use of lead paint and clashed with the powerful American Medical Association over the need for universal health care—the very same cause Zeke is working on today. Mother Marsha, a social worker, marched with Martin Luther King Jr., often bringing her sons along and sometimes ending up in jail. "Trying to change the world is high on our priority list," Zeke says.

So is closeness. Stuck with each other, the brothers created their own subculture—unlike most gifted high-energy kids, who must deal with the confusing feelings that come with being different. Like the X-Men at the Mutant Academy, the brothers felt most normal in one another's presence, where they could be themselves—with a vengeance.

The brotherhood may have been instrumental in curbing another hallmark of hypomania. If you're hypomanic and gifted, you always have the feeling of being the smartest guy in the room. But if you have two other guys just as smart and aggressive in the room who say, "That's a stupid idea" and start to pound you, it'll knock some of the grandiosity out of you.

The charisma, the big ideas, the action-orientation that link hypomania to leadership also win Rahm the loyalty of those who work under him. People like to be driven towards higher goals. But at the same time, he shows great consideration for people's needs and families.

A strong capacity for good fraternal relationships may help explain the unusually intimate chemistry between Obama and his chief of staff. "In meetings, it's not uncommon for Mr. Obama and Mr. Emanuel to engage in teasing banter," Leibovich wrote in The New York Times. When Obama complained during a meeting that Emanuel's knuckle-cracking was distracting him, Emanuel stood up and held "the offending knuckle" to Obama's ear and, "like an annoying little brother, snapped off a few special cracks."

Some heads of state might take offense at such irreverence. Emanuel was nearly fired from the Clinton White House for clashing with Hillary. But Obama, with his team-of-rivals approach, has shown a confident capacity to work with strong personalities. "Obama values truth-telling and bluntness" and he "has a lot of loving-teasing relationships," the Times' Leibovich told me. "The Emanuel dinner table represents his idealized cabinet meeting."

John Gartner, Ph.D., is a psychiatry professor, a PT blogger, and author of The Hypomanic Edge and In Search of Bill Clinton.

Larger than Life

When hypomanics succeed at something big, they often think they can achieve something impossibly huge.

• Christopher Columbus: Claimed he'd discovered the Garden of Eden and believed he was destined to usher in the apocalypse.
• Andrew Carnegie: After becoming the richest man in the world, he tried to stop World War I by building peace temples throughout Europe.
• George Patton: Corrected historians based on his "memory" of famous battles he'd fought in past lives.
• Jim Clark: After founding Silicon Graphics and Netscape, he started Healtheon, a company he predicted would solve the American health-care crisis. (It didn't.)

Click here for additional material on the brothers that didn't make it into the final article.