A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness

A FIRST-RATE MADNESS: UNCOVERING THE LINKS BETWEEN LEADERSHIP AND MENTAL ILLNESS by Nassir Ghaemi - A BOOK REVIEW James R. Fisher, Jr., Ph.D. © September 28, 2011 OVERVIEW The premise of this book is easy to reject, as it is counterintuitive. We prefer to think of our leaders being the epitome of stability, rationality and good sense, or on a higher plane of mental health than ourselves, not subject to the same peccadilloes, inconsistency and impulsivities that are common to our experience. If we read history, we know great leaders have had bouts with depression, melancholia, hypertension, anxiety and psychological pain. We choose to believe these are different experiences from our own, as if leadership required a differing humanity. Historians and psychiatrists have puzzled over the constitution of leaders, some great and some terrible, among them Napoleon, Lincoln, Churchill, Hitler, Gandhi, FDR, JFK, and even business leaders such as Ted Turner and religious leaders such as Martin Luther King, Jr. to see if existential patterns explained the panoramic scope of their leadership. The last thing we are likely to believe is that pessimism and mental disorder are common to them. We rest on the idea of leadership being of happy campers with positive optimistic points of view, not of wild fluctuations in personality or emotional instability. We want our leaders to be less than human so we may treat them as more than human. Research has shown, as Ghaemi points out, optimism is a coping mechanism that may make us feel happier but clouds our judgment to make rational and timely decisions. Moreover, creativity, a quality psychiatry has studied extensively, has a correlative relationship to bipolar disorders. Moreover, Ghaemi shows "depressive realism," a mental health malady, often comes to the fore with leaders handling crucial situations when pressed into a corner with no way out. This psychiatrist's thesis endeavors to show eminently sane men constantly fail in crisis: England's Neville Chamberlain's misreading of Hitler and Nazism, General George McClellan's timidity against the Confederacy in the American Civil War, President Jimmy Carter's reaction to the Iran Hostage Crisis and double digit unemployment, George W. Bush's preemptive invasion of Iraq after 9/11 with Great Britain's Prime Minister Tony Blair's complicit in the affair, all displays of leaderless leadership in crisis. Sane people are better at shepherding in good times, but are unequal to the task in hard times. In fact, the author insists, sanity can be a severe liability in moments of crisis. President Herbert Hoover, a most sane man of engineering acumen, had faith in capitalism to right itself during the Great Depression of 1929 with the illusion of optimism, "a chicken in every pot a car in every garage." Unemployment rose to a nation crippling 25 percent. Manic people, Ghaemi observes, are likely to push the envelop of sanity to the point of reckless abandon and sexual promiscuity. It may alarm the reader to learn that he found Hitler quite sane, a man who didn't smoke or drink, not even coffee, and Richard Nixon totally sane as well, puritanical to a fault, but a weak leader in crisis. POST FREUDIAN For the better part of the last hundred years, the explanatory model of Sigmund Freud of psychoanalysis has been accepted in the United States as scientific when it was impossible to replicate it in methodical studies. It was instead the talking cure to the iconic differentiation of the ego, superego and the id with the ego the "reality principle," the superego the "morality principle, and the id the "pleasure principle." We now know it was largely gleaned while Freud was in a cocaine high (see "Physician, Heal Thyself," Frederick Crews, New York Review, September 29, 2011, October 13, 2011). Ghaemi is not the first to challenge the probity of Freud's psychoanalysis but perhaps one of the first to take a quantum leap beyond it to show mania often occurs without depression, and that mania causes depression, rather than the reverse as Freud would insist. Moreover, Ghaemi sees successful leaders are often manic-depressive operatives: Mania is like a galloping horse: you win the race if you can hang on, or you fall off and never even finish . . . The core of mania is impulsivity with heightened energy. If to be manic means to be impulsive, then perhaps the expression of mania depends on how far the civilized veneer that holds our lives together is stretched. If it is stretched only a little, manic-depressive persons may function fine and actually be rewarded for their creativity and extraversion. If it is stretched too much, society disapproves, and tragedy may ensue (p.15). Proof that many are still locked into the Freudian model of psychology and psychohistory, both of which are now disputed and discredited, is the cavalier attempt of some critics to see clear writing and a challenging concept as pandering to the masses hungry for refreshing premises. I confess to being rich in Freudian thought but claim to be among this group with no apologies. Ghaemi uses psychological research and core studies against historical evidence to show the inverse law of sanity. The Cincinnati Chronicle in November 1961 claimed General William Tecumseh Sherman stark raving mad after being removed from Union command, only to reclaim it and become a symbol of the Civil War's horror with his devastating "March to the Sea" leaving a scorched trail from Atlanta through Georgia to the Atlantic Ocean. Sherman conceived the way to win the war was to totally demoralize the people by fear and dread. Historians, Michael Fellman for one, show Sherman was a crisis leader who caused much suffering but suffered much himself struggling with his demons. General Grant is given much of the credit for winning the Civil War, but the insanity of Sherman's march was the decisive blow to the South to which it never recovered. My work and writing has been with corporate leadership over the last sixty years, which supports Ghaemi's premise. I have experienced first hand the scepter of rule to which he refers. Non-crisis leaders, he argues, succeed in ordinary times, but are disasters in times of crisis. These leaders are idealistic, optimistic about the state of affairs and themselves, insensitive to the plight of workers, having little experience with suffering, often having come from privileged educations and backgrounds never exposed to working conditions or tested with any form of adversity. They see themselves as better than others while failing to see what they have in common with ordinary people and workers. They are nostalgic for the past, which has served them well, and seek to preserve it, and are threatened with those around them not cast in their mold, or appear inclined to risk, novelty or departure from that norm. I have seen them at all levels of management in diverse organizations as a laborer, technician, manager and executive in corporate and consulting roles. Mentally healthy to a person, never having suffered depression or mania or psychosis, never having seen a psychiatrist, they were (to a person) leaderless leaders in crisis situation. I have labeled this phenomenon corpocracy. It is the bane of these crisis driven times. CREATIVITY The author builds a case that Sherman was mentally ill, and for that illness transformed warfare from its nineteenth century incarnation into the total war that became endemic to the twentieth century, and now has been ratcheted up to terrorism in the twenty-first century. It is the ploy of psychological fear and dread that envelops us now. It was Aristotle that first linked creativity and depression as protocol to divergent thinking in the problem solving. We now call it thinking outside the box, but are careful not to associate it with madness. Ted Turner is profiled to show this amazingly candid man is open about his mental health. After a difficult childhood, a troublesome adolescence, manic mood swings in his young adulthood, then the suicide of his father, he reached deep inside himself and embraced his dread and soared to heights he could not have imagined. Turner created the 24/7 cable television news service when ABC, CBS and NBC were still contentedly playing in their little sand boxes. He has been a consistent explorer and challenger of the status quo along with remarkable displays of humanity giving much of his wealth to the United Nations. In 1991, he refused to remove reporters from Baghdad during its bombing by President George H. W. Bush, despite pleas from the White House. A decade later, no longer CNN's head, the network cowered to the demands of the White House like other networks with "embedded" reporters during the Second Gulf War. Reality was pushed off stage, and we are living in the surreal consequences of that action today. REALISM American workers, I have argued, have been relegated to "learned helplessness" in a state of suspended adolescence due to regimented conformity to draconian management dependence. I find here this is consistent with psychologist Martin Seligman's "learned helplessness" theory of depression proposed in 1967. Seligman reasons that depressed people see the world negatively because they are scarred by early hardship and learn to feel helpless. "Learned helplessness," in my context, is enforced management dependence in the workplace, which promotes passively, fails to encourage initiative or feedback from workers. To challenge management is a certain way to get into trouble. The psychologist's clinical trials show helplessness is likely to be displayed in symptoms of depression. Despair is often expressed in worker alienation from what they are paid to do. This not only takes a toll on productivity but on the worker as well. Depression is manifested in workers who contrive to be safe hirers responding to the invisible influence of the workplace swerving to what they perceive to be proper conduct instead of what the job requires. Not surprisingly, what are construed to be the best candidates to leadership positions are those most craftily inclined to this persuasion. In the last quarter century, passivity has been crippling American business and industry to the point of rising costs, shrinking profits, and disappearing markets. Human resources developed the scheme of the "illusion of control" implying that workers through the idea of empowerment, quality of work life, and participative management could feel involved in the decision making, when decisions they made were mainly cosmetic and inconsequential. This was not limited to blue-collar but also white-collar workers. Ghaemi refers to studies that show highly intelligent students from prestigious colleges and universities have as much an illusory sense of control as less educated workers. In my own work, mainly in engineering intensive workplaces, I have found a level of conformity and passivity complicit in this illusion of control. These students, workers and engineers would, in Ghaemi's lexicon, be considered psychologically healthy but most unrealistic in their "positive illusions," that is, unaware of their robotic cadence to someone else's drummer. Realism was sacrificed for peace and happiness, whereas the depressed person cannot escape realism. Ghaemi comes to two counterintuitive conclusions as to what it means to be normal: (1) Normal people overestimate their control of things; (2) Normal people find success inflates illusion whereas failure deflates illusion. The absence of early struggle and hardship often has negative effects on a person when difficult times arrive, when such a person is most vulnerable. Early triumphs can promote future failures. Persons who have encountered melancholy, loneliness, despair and failure, are inclined to embrace reality. They have the constitution to weather stormy days better than those who have had a free ride through life. * * * To illustrate his premise, the author profiles a number of historic figures who suffered various states of mental illness, and who had imposing clarity when it came to acting. Winston Churchill had a stormy career and was essentially benched when Adolf Hitler came to power in 1933. Ghaemi provides a detailed display of his assorted mental deficiencies while showing his unwavering conviction that Nazism threatened the survival of the Western world and the British Empire. Conversely, Prime Minister Neville Chamberlain, a man of uncomplicated demeanor and beaming mental health, reported after making concessions to Hitler in Munich in 1938 that he had secured "peace in our time." A year later Germany invaded Poland giving rise to the Second World War. Abraham Lincoln suffered extreme bouts of depression and melancholy all his life. Reality was his boilerplate, repeated failure his companion, haunting nightmares his muse. In 1841, when he was thirty-two, he wrote: I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better I cannot tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me. EMPATHY When depressed, Ghaemi argues, one knows the truth of empathy. It is a visceral feeling of unity with other people. Lincoln used it in one sense, Sherman in another. Lincoln would do anything to protect the integrity of the nation, Sherman anything to break the will of the South. Negative emotions like pain and suffering have been the focus of psychiatry rather than the positive emotions of empathy. Neurologically, little has been known until recently about empathy. The conclusion is empathy is not a vague concept but a neurological fact. Cognitive empathy relates to thinking another person's thoughts; affective empathy involves feeling an emotion another person feels; motor empathy relates to moving the way another moves; and sensitive empathy means feeling a physical sensation another person feels. Empathy is central to the human experience and central as well to the experience of depression. We are wired to experience it in our brain and in our body, and therefore, it is central to our mental life. Depression deepens our natural empathy. Mahatma Gandhi and Martin Luther King, Jr. are bookends to depressive activism. They attempted suicide as teenagers, endured depressive episodes in midlife, and suffered severe depressive episodes in their final years before they were both assassinated. King and Gandhi accepted violence, but saw nonviolent resistance as a better alternative. Like violence, their nonviolence was aggressive, but spiritually not physically so. It was active, refusing to accept evil, standing up and their ground without inflicting harm. RESILIENCE Some people are neither depressed nor manic, but they aren't necessarily mentally healthy either. They have, what Ghaemi calls, abnormal personalities or temperaments, which is just as biological as mental illness although most of us think otherwise. Studies of personality identify three basic traits common to all people: neuroticism, extraversion, and openness to experience. We're all more or less anxious (neuroticism), sociable (extraversion), and subject to risk taking (openness to experience.). This leads to personality types. Some of us are always a little depressed, low in energy, need more than eight hours of sleep, and are introverted. This personality type is called dysthymia. Others are always upbeat, outgoing, displaying a high energy level, need less than eight hours of sleep, and have more libido than most of us. This personality type is called hyperthymia. This type often occurs in great leaders such as FDR and JFK. Some people are a little of both, alternating between low and high mood swings and energy levels. This personality type is called cyclothymia. Resilience is what psychologists call "good outcomes in spite of serious threats to adaptation or development." Resilience grows out of an interaction between hyperthymia personality and harmful events producing a good outcome in the end. Resilience is a condition in which people get stronger after steeling themselves against stress or adversity. Resilience is the mind's vaccine. FDR experienced polio in the flush of his manhood. Nietzsche famously said what does not kill you makes you stronger. He understood resilience. FDR's malady was physical, but led to bouts of painful depression. He overcame them to lead the United States through the Great Depression and WWII. Sherman and Churchill suffered manic depression all their lives, but became resilient and effective demonstrating their hyperthymia personalities. Ghaemi shows that children of poor socio-economic circumstances can be resilient and enjoy well-adjusted adult lives because of social support. Children who lack such support may experience hardship or trauma. Poverty is often a hardship, a chronic problem that can be long lasting despite changing circumstances. A person once scarred with poverty does not always escape it once rich. I knew a multi-millionaire who would not go to four-star restaurants because he claimed to have nothing in common "with those people." Trauma is more intense and acute but short lasting. Personality traits that reflect biological temperaments are usually set by the age of three, and persist throughout adulthood. Evidence of the steeling effect is a classic study that followed children of the Great Depression into adulthood. Many who had experienced childhood poverty grew up to be psychologically healthy, but not always resilient. FDR, who came from the America's aristocracy, was said by Supreme Court Justice Oliver Wendell Holmes to have a first-rate temperament but a second-rate mind. He was a hyperthymic personality: energetic, extremely talkative, outgoing, extraverted and good company. He was not an accomplished administrator, or an organized person, much less a conceptual thinker, but rather a whirlwind leader and entrepreneurial president, not afraid to try something new, or to try something else if it failed, always thinking ahead, never locked into ideology or political philosophy. He was a man of action never limited to what was pragmatic. Hyperthymia is key to FDR's psychology. It made him open to new ideas, and charismatic, but also in the face of his polio, it helped to make him resilient. JFK never suffered polio but fought a series of physical maladies from an early age and throughout his entire life. At the age of 13, he was hospitalized with severe abdominal pain, which would constantly reoccur. He had a weak immune system; a knee scrape would lead to severe infection. He suffered frequent colds, ear infections, and influenza. At 17, he nearly died from a high fever, diagnosed with fatal leukemia and was given a 5 percent chance of survival. Later, he suffered Addison's disease with a series of relapses. He felt ashamed of his illness and weakness and endeavored to compete in sports and promiscuous affairs with reckless abandon. One reason he kept going was his hyperthymic temperament. His disease was not a full-blown mania but a condition spiked by his self-medication, seeking to enhance his hyperthymic traits. He was always talking about dying, about escaping pain, which inevitably influenced his reckless lifestyle and vacillation on policy as president. FDR and JFK went to the edge feeling something or someone was watching over them that would right their wrongs and save them from their excesses. History suggests providence was with them. TREATMENT JFK's situation differs with other leaders discussed here. He engaged in self-treatment of steroids and other agents (amphetamines, barbiturates, cocaine analogues), abusing anabolic steroids for their psychiatric effects. This caused manic and depressive mood swings that harmed his ability to lead. Once his physicians got control of these medications, they not only kept him alive, but enhanced his functioning and decision-making. JFK had two distinct phases of his presidency: early failures and late successes. The Bay of Pigs disaster and the botched summit in Vienna with Soviet leader Khrushchev led to his retreat in Berlin resulting in the Berlin Wall separating that great city. He waffled on civil rights and was unable to pass his election platform. Few new (during this period) he was under heavy medication suffering Addison's disease, and the psychiatric effects of anabolic steroid abuse. The second phase (1962 - 1963) saw him adroitly handling the Cuban Missile Crisis, a triumphant visit to Berlin with vigorous support for the civil rights movement, peaking when he was assassinated in Dallas in 1963. During this phase, his medical treatment was under control enhancing his resilience rather than impairing it. Adolf Hitler seems on the surface to be tyrannically insane and abominably evil, far from empathic, realistic, creative or resilient, yet he was all of these. He abused intravenous amphetamines, and suffered a bipolar disorder with spontaneous severe depressive and manic episodes since his youth. His manic symptoms included overtalkativenes, grandiosity, euphoric mood swings, decreased need for sleep, and hyperactivity, all occurring episodically, alternating with bouts of depression common to a bipolar disorder. Prewar Hitler's mental illness was no more severe than Churchill's. He was resilient and creative, astute, a realistic politician, empathetic but also violent killing political opponents, which as Ghaemi showed earlier is not inconsistent with empathy (re: Gandhi and King). In 1937, he began using amphetamines. Before, his bipolar disorder seemed manageable adding to his productivity and creativity. After that date, a gradual decline began. Ghaemi goes into an extensive review of his soaring reliance on medication and his deteriorating decision-making, ending in colossal defeats. The dramatically divergent trajectories of Hitler and JFK show how important drugs are a factor in mental illness. In leadership, as in life in general, cavalier use of prescription drugs can make a major difference. This is truer today with scores of new drugs available for every conceivable malady. Ghaemi still insists that excluding the mentally ill from positions of power is truly unwise especially in times of crisis, as the mentally challenged are likely to see more clearly and deal more effectively with the reality of the situation. MENTAL HEALTH Homoclite Leaders: Bush, Blair, Nixon, and Others The author ends this fascinating ride into a counterintuitive framework with a discussion of what he calls homoclite leaders, a term derived from psychiatrist Roy Grinker to indicate "those who follow a common rule," that is, leaders who are essentially sane, healthy, happy, and successful in life. Prime Minister Neville Chamberlain and Civil War General George McClellan come quickly to mind. These men had perfect credentials and pedigrees but were terrible leaders. Ghaemi's premise is that their mental health hampered their leadership. Grinker made a study in Chicago of a YMCA-run college of 343 people with sixty-five men falling into the healthy range. He then interviewed this group individually. They were from white and blue collar families with above average IQ's, average college grades (mostly C's), no childhood or adolescent conflicts with well established parental discipline seeing constraints as beneficial and reasonable, the great majority (85 percent) lacked even the mildest mental abnormality. He anticipated the Nixonian concept of the "Silent Majority." This group, which proved a significant proportion of the American population in 1962, was relatively silent, goal-directed, conforming, anxious to please, ambitious to be upwardly mobile economically and socially, to do good, do well and be well liked. They were a complacent herd that Eric Hoffer profiled in "The True Believer" (1951); lives carried out quietly in simple comfort with common expectations of being married, having families, and retiring on small pensions with social security. They were a solid core group of stability, middle-of-the-roaders, neither liberal nor conservative, neither hoarders nor speculators, neither tightlipped nor high steppers. I grew up with people of this ilk, as it describes my hometown, people who saw the cultural benefits of homoclites. Ghaemi quotes Grinker: Without them the ambitious, fast-moving climbers would slip into the mire of political, social, and economic chaos. They are not only Kansas they are America. (p. 213) Unsuitable for leadership, they have been unable to see beyond themselves as to what constitutes the leadership they need. They have instead elected leaders or submitted themselves to work for leaders like themselves. We are now in the dog days of that blighted afternoon. Grinker continues: To have a population of relative stability is necessary for the activity of those who process creativity . . . Every country needs its proletariat, using the word in Toynbee's sense. It constitutes the majority which is led by the creative individual who withdraws from his society, returning to lead it in the light of his discoveries.(p. 213) That doesn't seem to be happening. Monochromic homoclites like Chamberlain and McClellan, leaders devoid of emotional and psychological nuance, dominate leaderless leadership of society today. There are no Churchills or Shermans. They were often sane, but when they were mad they reached inside themselves to find that creative spark to conquer the chaos and crisis that portends to swallow them up in gloom and doom. The author's analysis finds Reagan, Eisenhower, and Truman homoclites, essentially level headed and successful as presidents, as they never had to handle major crisis like WWII (which was nearly over when Truman took office), or nuclear standoff (Reagan never faced a Cuban Missile Crisis), or the civil war crisis (Eisenhower intervened in Little Rock, and otherwise avoided conflict including the British-French bombing of the Suez Canal). Richard Nixon is often thought of as an insane failure as president. His fall is legendary with the consensus that he was paranoid, depressive, and delusional. Ghaemi insists he was none of these, except near the end of his presidency when engulfed in a crisis of his own making. He was then drinking, depressed and perhaps suicidal in the summer of 1974 before he resigned his presidency. Otherwise, Nixon was basically a normal guy, neither mentally ill nor abnormal. He was not a classic homoclite, or a normal range personality. He had his quirks. That said the author claims he had the misfortune to become president at the cultural peak in the 1970s of psychoanalysis. Countless books and articles claimed he was "having a nervous breakdown," was "insecure and a narcissistic personality," had a "frail ego," which triggered "angry outbursts," all of which is Freudian gibberish without scientific meaning. Many reading this have been painted with that same broad brush of nonsense, especially in the corporation, throwing their careers and lives into a tailspin. Having read books on Nixon by both attractors and detractors, they confirm he had a warm friendship with JFK when they were junior senators, and had refused to authorize a recount of votes in Illinois when it was alleged Mayor Dailey stuffed the ballot box for Kennedy in 1960. Ghaemi is adamant Nixon lacked the madness of such as Lincoln, Sherman and Churchill, successful in peacetime, but a horrible failure in times of crisis. The author goes on to show that president George W. Bush and British Prime Minister Tony Blair were classic homoclites, demonstrating this in how they reacted to 9/11 and the terrorist attack on the Twin Towers of New York City and the Pentagon in Washington, DC. Ghaemi shows how their collective sanity sabotaged their efforts to do the right thing. CULTURAL STIGMA Traditional psychiatrists and mental health professionals may discount this work, not written in jargon, for being comprehensible to general readers. They may also discount its premise that sanity does not ensure good leadership, while mental illness often does. That is a legitimate criticism and concern. Ghaemi's point is that the wrong or inappropriate levels of medication can, and has led to evil leadership. The author's premise is that sanity is not always good nor insanity always bad when it comes to leadership in crisis. Sane leaders tend to be tentative or circumspect; insane leaders are inclined to be bold and incautious. Ghaemi develops his premise in the political arena, but I see its application to the corporate world as well. This is not a definitive work. It is a thesis counter to the deep cultural stigma that those who step out of the norm and take charge, act rashly, not waiting for approval or the dust to settle are renegades and not leaders. Leadership implies that it takes mental health and straight arrows to lead even now in the twenty-first century. Millions of college graduates, some from the most prestigious universities in the land fulfill this ideal type, but Ghaemi would insist, and the record seems to confirm his thesis, they cannot lead in crisis, and society currently is in constant crisis. In the corporate world, to protest an intervention or hold forth an adversary point of view could result in your being fired, downgraded or sent off to some mental health professional to check your sanity. Sanity is what corpocracy subscribes to, and sanity is proving its wrecking ball. "A First-Rate Madness" resonates with me as I alluded to nearly a score of years ago in "The Worker, Alone! Going Against the Grain" (1995). I wrote then: There is a long-standing belief that the mentally healthy are more likely to have a deficient perception of reality than depressives. Depressives, so the argument goes, are better informed about their poor standing in the eyes of others than the healthy-minded. As they become less depressed, however, they discern an illusory increase in popularity. As you shall see, I hold little confidence with this argument. On the contrary, I feel the worker's survival is predicated on embracing reality, not denying it; on riding reality like the bull that it is until tempered to the worker's purpose. (Preface, p. 1) * * *

The next time you hear someone suggest that a politician is crazy, you might want to consider the benefits of keeping her in office! In the book, A First-Rate Madness by Nassir Ghaemi, a professor of psychiatry at Tufts University School of Medicine and director of the Mood Disorders Program at Tufts Medical Center in Boston, Dr. Ghaemi sets forth this thesis: The best crisis leaders are either mentally ill or mentally abnormal; the worst crisis leaders are mentally healthy. Sure to raise all kinds of eye-bulging arguments between otherwise friendly people is the notion that our best interests are sometimes served best by those who could be diagnosed as manic depressive, bipolar, or clinically depressed. Dr. Ghaemi's thesis is based on his study of the psychological history of some of the most effective leaders during times of crisis. Included in his survey are Civil War general, William T. Sherman, FDR, Ted Turner, Martin Luther King, Jr., John F. Kennedy, and in a different sort of way, Adolf Hitler. He uses four areas of analysis: realism, creativity, empathy, resilience. These four characteristics of leadership, Dr. Ghaemi argues, are also characteristics found in large supply among the depressed and manic during times of crisis. He explains that the type of thinking and courses of action required to navigate people through tough times are usually unconventional and would not normally occur to those who are mentally healthy. When creative thinking is needed, it is not a matter of intelligence that is required; rather, it is the ability to assess reality in its deepest and most honest sense. Then, the effective leader must initiate bold actions, sometimes unorthodox, that respond to the right issues at the right time. Kennedy's response to Kruschev during the Cuban missile crisis is an example of this creative leadership and risky action, culminating in a meteoric rise of a nation's confidence in its president. Only those who can synchronize with reality are able to know what the right issues are at the right moment. This "depressive realism," Ghaemi argues, is one of the benefits of depression just as creativity and resilience are beneficial characteristics of the manic phase of manic-depressive illness. The arguments put forth by Dr. Ghaemi are based on a controversial method of studying history, that is, with the purpose of gleaning psychological evidence of mental health or illness. He dismisses critics somewhat convincingly in the introduction to his book by pointing out that historical perspective is more accurate than that of the present. He says we see the past much more clearly, making more precise judgments about it, than we are able to see and do in the present. In applying this method he is dependent on anecdotal evidence, and upon documents written by people, such as spouses, whose assessments can be too subjective at times. The reader can never be quite sure that all the pieces have been pulled together, though Dr. Ghaemi offers multiple sources in his evaluation. The stories match up beautifully with his propositions, sometimes, perhaps, too beautifully. Still, the crux of his argument is convincing and worthy of much deeper exploration in future works. Perhaps, in Dr. Ghaemi's next book, which I look forward to reading, it would be helpful to take his thesis to the next step and describe it in relation to common everyday people, such as civic leaders and entrepreneurs. He is onto something in this book, and it merits more attention. I would also like to see what Dr. Ghaemi has to say about the implications of his thesis for psychiatric practice and for those living with manic depressive illness. Is there a way to "coach" depressed persons, or those with manic episodes, into greater creativity, and ultimately productivity? Those who frequently read books on leadership and/or psychology will find A First-Rate Madness to be insightful and extraordinary. Readers will see the soft spots in the thesis, spots, I believe, that Dr. Ghaemi also acknowledges. He is, after all, placing before the reading public the notion that mental illness has benefits that are sometimes only available to those who suffer from it. I don't mean to claim that it always takes a disturbed person to have a nuanced and humble view of life and the world. Many probably mentally healthy leaders are also complex and insightful.... My claim is that mental illnesses, like depression, do not detract from such abilities, but in fact can enhance them. (p. 260) Recommended. Article first published as Book Review: A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness by Nassir Ghaemi on Blogcritics.

This is the best book I have read all year. First of all, Dr. Ghaemi is a world-class psychiatrist; he is THE expert on issues of mood disorder (my wife is a psychiatrist and says that Dr. Ghaemi is the very best in the nation in his Continuing Medical Education teaching). So, he truly knows what he is writing about. The structure of the book essentially follows the pattern of a chapter which describes the state-of-the-art in psychiatry as to a given diagnosis, followed by mini-biographies in two chapters of two historical figures who are exemplars of leadership with the particular diagnosis that Dr. Ghaemi has described. The manner in which he uses historical evidence to arrive at his diagnosis is seamless. Among the historical figures profiled are Lincoln, General Sherman, Hitler, Gandhi, Churchill, Martin Luther King, Jr., FDR and JFK. There is a profile of Ted Turner, unusual because he is the only living example profiled (and the only non-political leader). Toward the end of the book there is extensive commentary about Nixon, Dubya, Tony Blair and some insights about Clinton, Truman, Eisenhower and even Newt Gingrich along the way. I have read at least one biography of each figure he profiles (except for Ted Turner). I can vouch for the historical accuracy of Dr. Ghaemi's book in all regards except for two minor points about FDR: he was not a member of Woodrow Wilson's cabinet and he was not Secretary of the Navy (he was #2, the Assistant Secretary of the Navy). The endnotes are also a magnificent treasure-trove of information. Superb book, well-written by someone who knows his material. I won't spoil your enjoyment with details about the profiles, but the essential thesis of the book is that we stigmatize mental illness but with the paradox that the very finest leaders in times of crisis or great challenge are mentally ill (sufficiently mentally ill to be great and effective leaders but not too much to have become incapacitated such as the monster Hitler). Read. Enjoy. Benefit from this book.

This book was educational regarding some of history’s more famous leaders like Winston Churchill, JFK, and Abraham Lincoln to name a few. The premise of the book is a psychological look at some of the leaders during very challenging times and their mental issues like depression and how that may have made them more successful. I’m sure it’s a controversial subject but the author makes some interesting points. The failures of leaders that we consider normal is contrasted with successful leaders with known mental issues. I found the book to be educational and thought - provoking.

Although this book may initially provide some interesting reading, I find it leads to, at least in one instance, some premature conclusions without complete and accurate information. As one previous reviewer wrote, the author: "contrives the data to fit his thesis". I think at least on one of the personalities he wrote about I could honestly say his thinking was seriously flawed. In Chapter Ten "A First Rate Temperament: Roosevelt" the author describes former President Franklin Delano Roosevelt as someone whose hyperthymic personality "made him open to new ideas, and charismatic, but also, in the face of polio, hyperthymia helped him to be resilient, to rise above and better understand human suffering....His mind was agile and he did not recoil from the most terrible of decisions...He knew only people were hurting; he knew what it was like to hurt; and his personality would not allow him to sit still. He tried whatever worked and with that method achieved astounding success." The author writes that Roosevelt's polio "seems to have given him a degree of empathy that we've seen in other leaders who endured depression." An agile mind? Not recoiling from terrible decisions? Increased empathy? I hardly think so and would STRONGLY disagree with that conclusion knowing what I know about the "rest of the story" as a Lithuanian-American whose parents fled their native country to escape certain death, imprisonment or forced deportation by Soviet occupation armies in 1944. Take Roosevelt's behavior at the Yalta conference in February 1945 as detailed in retired Lt Colonel Nargele's book Terror Survivors and Freedom Fighters and in Lithuanian partisan resistance fighter Juozas Luksa's book Forest Brothers: The Account of an Anti-soviet Lithuanian Freedom Fighter, 1944-1948 Roosevelt turned his back on scores of innocent people forcibly occupied by the Soviets at the end of the war. His were NOT the actions of a man whose intellect was "hardly inferior", one to whom "Innovations never frightened" and who "knew a little about almost anything". Roosevelt was in fact foolish when he was quoted as stating "let it slip that the United States would not protest if the Soviet Union attempted to annex the three Baltic States." His ignorance and lack of concern costs thousands of Baltic people their lives. While Roosevelt chummied up to "Uncle Joe" (Stalin) the Soviets carried out a program of genocide from 1941 throughout the 1950's in the Baltics with, as Laime Vince states, in the introduction to Forest Brothers: The Account of an Anti-soviet Lithuanian Freedom Fighter, 1944-1948 "the goal of subduing the local population and integrating it into the Soviet Union. Those who resisted...were disposed of by being transported via cattle car to hard labor camps in Siberia ....During these years the Soviets deported about 130,000 people from Lithuania ....In total about 118,599 Lithuanias died in Siberia." At Yalta this supposedly "empathic" President who "knew only that people were hurting" agreed not only to give Stalin everything he wanted at Yalta but MUCH MORE "to include the destruction of Dresden ahd Hamburg, the enslavement of Lithuania, Latvia and Estonia, and all of Eastern Europe". This from the type of man the author depicted him of being? Hardly. I am not as much aware of other discrepancies in this book but having read some of the other reviewers comments ,it causes one to pause as to the validity of other conclusions made in the book. It is, of course, fascinating reading in some areas but the book's inaccuracies can be disturbing. I, therefore, can only really give the book an average rating.

I really enjoyed this book. It’s both very readable and very educational. As far as books about mental health, it’s quite unique as it grounds it’s arguments and insights in famous leaders in history. My Dad, who wouldn’t be caught dead reading a self-help book about mental health, gladly read this and found it very insightful about figures who he has learned about in depth before (Churchill, Lincoln, FDR.) As someone with bipolar who has done a lot of research into manic depression, I found the premise of the book and the analysis very fresh and best of all, empowering. Would highly recommend to anyone with an interest in history, leadership, or mental health.

Many thanks to Dr. Ghaemi for emboldening the efforts by many to remove fully the stigma of mental illness. He provides extensive education and shines a light for broader understanding and sensitivity. I was mesmerized by the detailed and compelling account of JFK's varying mental/medical conditions. Dr. Ghaemi is the first scholar to have access to JFK's full medical records, which only became available several years ago. After reading and re-reading the JFK chapters, I'm completely convinced that JFK's health--and the wide, often unsupervised vacillations in its treatment--explain much about the man. For me, that analysis is well worth the price of the book alone. Dr. Ghaemi convincingly establishes JFK's hyperthymic nature. A startling medical "coup d'etat" in the handling of JFK's treatment occurred mid-way through his presidency. Out went the blank checks on administering all kinds of steroids and other drugs that, as Dr. Ghaemi shows, resulted in JFK stumbling re the Bay of Pigs, in his initial meeting with Krushchev. In went medically appropriate combinations and dosages. The new drug regime had the desired effects and, the author argued, enabled JFK to make the type of creative leadership decisions embodied by, e.g., the US approach to the Cuban Missile Crisis. In other words, he, and the nation, were able to benefit from his hyperthymia. I believe that no future study of JFK will be possible without fully taking into account Dr. Ghaemi's findings. On the other hand, and as a long-time student and admirer also of FDR, I came away unconvinced that FDR was hyperthymic. Dr. Ghaemi's reliance, for a showing of family history of illness, on an unnamed Hyde Park neighbor's characterization of FDR's grandfather as "'a queer duck'" strikes me as too slender a reed. More likely, in my view, FDR's polio trials and tribulations meaningfully account for a number of his great leadership traits, like boundless empathy. The FDR section made me wish most that Dr. Ghaemi had collaborated with a bona fide historian. I hope Dr. Ghaemi some day has the chance to assess Theodore Roosevelt--another great, in my opinion, during fast-changing times. The landmark three-part biography by Edmund Morris leaves me almost certain that TR was bipolar and that the country benefited from his condition. Dr. Ghaemi's studies of the role of dysthymia in leadership are not surprising in their subjects (e.g., Lincoln, MLK, Gandhi, Churchill). The author's unique contribution in this regard, rather, is in hammering home the similarities of so many courageous and effective leaders. My own jury is out on the author's contrasting analyses of those leaders too normal or healthy to have brought extraordinary empathy and creativity to bear (e.g., G. W. Bush, Blair). I'm not sure the author even needed to "go there" to make his central thesis. btw, the sourcing is superb, as is the extensive bibliography. All in all, a captivating thesis, sometimes rooted firmly in historical fact, sometimes not so...but most helpful and thought-provoking. On my bookshelf, this work becomes a companion to Dr. Kay Jamison's extraordinary "Touched With Fire: Manic Depressive Illness and the Artistic Temperament."

I saw the author interviewed on the Daily Show and had to buy this book. Ghaemi's contention is that a crisis calls for extraordinary leaders and that "normal" folks just don't cut it. They're not creative or realistic enough in their thinking. (Depending on the need of the moment.) FDR was hyperthymic and he was able to be creative in responding to the Great Depression. He tried different things; if they didn't work, he tried something else. But he didn't think conventionally. Churchill, on the other hand, was a "depressive realist". He suffered from depression but not mania. New studies now find that people who have experienced depression are more realistic than "normal" people, who tend to be unrealistically optimistic. Churchill's "depressive realism" allowed him to see the danger in Hitler's Germany when all the normal people, like Neville Chamberlain, could not. Sadly, Churchill was right. I can't say that Ghaemi is correct in all he says, but the argument is persuasive. I do know that I'll never look at a political leader again without trying to assess his or her mental health. Not sure if that is a good thing or not, but I will look at them differently!

The author puts forward the notion that in times of crises few great men are mentally healthy and few mentally healthy men are great leaders. General McLellan did well in peace time and failed during the civil war, while manic-depressive General Sherman failed during peace time and excelled during war. A similar comparison is made between British Prime Ministers Neville Chamberlain and Winston Churchill. An intriguing case is made regarding how a change in medications helped make JFK a better President while increasing drug abuse (methamphetamines) helped make Hitler even more unhinged. A must read for any student of history or of psychology and anyone looking to challenge the current prejudices regarding mental illness.

Gli argomenti trattati sono interessantissimi, prendendo come esempi leader famosi, da Ted Turner a Martin Luther King. Il suo unico difetto è che a volte ripete i concetti qualche volta di troppo, ma non compromette troppo la lettura.

This is a fantastic book. I read it in almost one day (could not though). Author brilliantly examines, identifies and explains psychiatric conditions in some of USA's most beloved leaders. Helped me to understand behaviours that hitherto were somewhat opaque. Author is also using primary sources hitherto unutilized by other forensic historians. Top rating,

Durch dieses Buch erfährt man mehr über Geschichte und Psychische Erkrankungen, die sehr gut argumentierte und kenntnisreich belegte Verknüpfung ist das besondere, und für mich originelle. Es trifft auch die richtige Balance zwischen faktenreichem Sachbuch und gut lesbarem erzählendem Text

Thoroughly enjoyed this book. Enjoyed the insight to some of our world leaders and how similar their illnesses were. Great Bookclub read.