A First-Rate Madness

A First-Rate Madness: 

Uncovering the Links between Leadership and Mental Illness

By Nasir Ghaemi, M. D.

Review by John E. Wade II

This is a fascinating book, explaining in a compelling manner how some of the greatest leaders of the past two centuries—Abraham Lincoln, Gen. William T. Sherman, Winston Churchill, Mohandas Gandhi, Franklin D. Roosevelt, John F. Kennedy, Dr. Martin Luther King, Jr., and Ted Turner among others—drew from their personal suffering to evoke sterling leadership abilities under the harshest circumstances.  The author also addresses the “flip side,” that is, weak leaders such as Neville Chamberlain who didn’t perceive the threat of Adolf Hitler.  He also presents a disturbing account of Hitler and his untreated and mistreated bipolar disorder, as well as the top echelon of his command who carried out his evil orders.

I urge everyone to read the complete book to come to understand, as I do, that unusual times call for extraordinary leadership, whereas ordinary times are better served by leaders who help “the trains run on time,” whether political, military or business.

For crisis leadership, bipolar disorder (with its mania and depression) can present vital elements of effectiveness, such as realism, resilience, empathy and creativity.  Depression invokes all four of those elements while mania promotes creativity and resilience.  Personally, I’d like to add one more quality to the three “high” states that the author presents (hyperthymia seen in Franklin D. Roosevelt (FDR hereafter) and John F. Kennedy (JKF hereafter); hypomania exhibited by Churchill; and mania in Sherman and Turner), that of high energy.

Let’s go through the book with an open mind and a certain sense of awe that these leaders (excluding Hitler, of course) performed in a superb way beyond the limits where many in that situation would give up, as FDR with polio and JFK with Addison’s disease.

The book examines eight great leaders in “politics, military and business whose lives and work demonstrate various dimensions of the link between leadership and madness:  General William Tecumseh Sherman of Civil War fame; Ted Turner; Winston Churchill; Abraham Lincoln; Mahatma Gandhi; Martin Luther King, Jr., Franklin D. Roosevelt (FDR); and John F. Kennedy (JFK).”  He also presents counterexamples of  healthy “normal” leaders who failed in time of crisis:  Richard Nixon, General George McClellan and Neville Chamberlain.

In this review I will not include all the figures that Dr. Ghaemi addresses, but will try to illustrate how democratic societies might have come to the point that only “normal” candidates can rise to great leadership even though such persons with depression (Lincoln and Churchill), creativity (Sherman and Turner), depression coupled with radical empathy (Gandhi and King), and resilience (FDR and JFK) can rise as necessary to handle times of great crisis.

The author, Nassir Ghaemi, M. D., is a professor of psychiatry at Tufts University School of Medicine.  He trained in psychiatry at Harvard Medical School, holds degrees in history (BA, George Mason University), philosophy (MA, Tufts) and public health (MPH, Harvard).

In identifying and analyzing these prominent individuals he used four criteria:  symptoms, genetics, cause of illness and treatment.  I will not duplicate his application of those telling standards on each figure, but I will say that I found his methodology and thoroughness completely convincing.

The author explains that “…  mental illness doesn’t mean that one is simply insane, out of touch with reality, psychotic.  The most common mental disorders usually have nothing to do with thinking at all, but rather abnormal mood:  depression and mania.  These moods aren’t constant.”

There is a growing “depressive realism hypothesis” which points out that “… depressed people aren’t depressed because they distort reality; they’re depressed because they see reality more clearly than other people do.”  This applies to Winston Churchill as he vividly saw the great threat of the rise of Adolf Hitler.

Mania can be accompanied by “… creativity, energy and sociability….” but if it is too pronounced it can lead to “… irritability, promiscuous sexuality, and lavish spending.”  The core of mania is “impulsivity with heightened energy.”

An early twentieth century German psychiatrist, Erst Kretschmer, said “Insanity is not a regrettable … accident but the indispensable catalyst of genius.”  The author states categorically that “The best crisis leaders are the mentally ill or mentally abnormal; the worst crisis leaders are mentally healthy.”  When writing of these crisis leaders he states, “The weakness is, in short, the secret of their strength.”

Just a brief comment about Sherman, a Union general who broke the back of the Confederacy with his unprecedented march through Georgia—burning Atlanta—on to Augusta, with similar tactics all the way through South Carolina to North Carolina.   “A month later, the war was over.”  Despite his mental breakdowns in the past, “With all this military success, Sherman had rehabilitated his image from crazy failure to insane genius.”

Creativity in any realm is not just solving old problems, but finding new problems to solve.  “Mania enhances both aspects of creativity:  the divergence of thought allows one to identify new problems, and the intense energy keeps one going till the problem is solved.”

Let’s briefly address Ted Turner, a legend in his own time in many ways.  The author states “I believe Turner was a success because of, rather than despite, his bipolar symptoms.”  Turner’s “… manic energy and creativity are relatively clear.”

Interestingly, the author relates that Leston Havens, a wise psychotherapist, once commented that he had known many people who had been improved by failure, and many ruined by success.  Failure deflates illusion, while success only makes illusion worse.  That’s a powerful assessment of human nature.  The author explains how early hardships in life—particularly harsh ones—tend to produce, “not infrequently, our greatest leaders.”

One of my personal heroes is Winston Churchill, who stood staunchly during World War II, inspiring Britain and the Allies to achieve their ultimate victory over Adolf Hitler, another figure examined in the book.  The author writes, “I believe that Churchill’s severe recurrent depressive episodes heightened his ability to realistically assess the threat that Germany posed.”

In describing Churchill from a psychiatric point of view, the author writes that Churchill “… meets the official definition of bipolar disorder, type II (hypomania alternating with severe depression).  It is also possible that he had more severe manic episodes, which we cannot fully document, yet had that been the case he would meet the diagnostic definition of standard bipolar disorder (also called type I).”

His mind never stopped.  Churchill was amazingly productive, aside from serving as minister and prime minister for decades; he wrote forty-three books in seventy-two volumes.  Because Churchill had battled illness and despair his whole life, he could and did convey to others that despair could be overcome, even in the bleak period of 1940.  He called his depression his “Black Dog.”  It’s as if he suffered and gained what the author called “depressive realism,” allowing him to recognize as early as October, 1930, the Hitler menace and to lead when his deep fears were realized.

Abraham Lincoln also demonstrated the worthwhile impact of depression and how it fostered empathy and tenacity.   Lincoln had a history of depression, including suicidal thoughts, telling a fellow politician that he “was the victim of terrible melancholy” sometimes, so he never carried a pocketknife because he couldn’t trust himself with it.  Lincoln sought compromise, but “after Fort Sumter, he realized that compromise was lost.”  He said slavery was the “… greatest wrong inflicted on any people.”

There have been a few leaders, like Mahatma Gandhi and Martin Luther King, Jr., who had intently experienced depression, and out of sheer force of will made it a part of their political method.  The author states that he believes the “politics of radical empathy …  is the psychological underpinning of non-violent resistance.  Depression reveals the truth of empathy, and empathy, in turn, engenders unexpected powers of leadership.”

The author explains that “Emotional empathy, produced by severe depressive episodes, may prepare the mind for a long-term habit of appreciating others’ points of view.”  In my words, depression can produce a humble spirit that exudes kindness.

Both Gandhi and King suffered depression and yet were heroes in peace as Winston Churchill was a champion in wartime.

Dr. Poussaint gave a first-hand account, “King had a heartlessness about him … he set the pace in marches, he was strolling, not walking fast, nor slow; but strolling, and always right in the front line, which put him at risk.  Anyone could run out from the bushes and shoot him.”  King was not chronically depressed but “… experienced at least three probable depressive episodes in the beginning, middle and end of his life, the first associated with suicide attempts.”

The author does state, “No form of waging conflict always wins.”  Radical empathy in a non-violent way won the day for Gandhi and King, whereas Churchill and the Allies won World War II through warfare.

Humankind must learn to integrate nations, economies, investments, and communications, even religions in ways that reduce and eventually eliminate conflict.

President Franklin Roosevelt was described by a famous judge as having “… a first rate temperament.”  Psychologically the author described FDR’s personality as hyperthymic—high in energy, very talkative, outgoing, and extroverted and, in short, extremely good company.  During his thirteen years in the presidency, he traveled by rail 399 times, covering 545,000 miles.  FDR was the epitome of resilience, partly due to his temperament but also probably the result of his polio, contracted at the age of thirty-nine as he was a rising star politically.

A close aide, Robert Jackson, regarded FDR’s sociability as his strongest asset—“He liked people, almost any people.”  The author explains that “… people with a hyperthymic personality tend to score very high on openness to experience, and they are curious, inventive, experimental souls.”

Emerging from his battle with polio that would hamper him physically the rest of his life, FDR became “… completely warmhearted, with humility of spirit and with a deeper philosophy.”  FDR’s hyperthymic personality helped him combat the polio which in turn endowed him with a degree of empathy which served the nation, world and him well.

President John F. Kennedy also possessed a hyperthymic personality.  He suffered with dismal physical problems from severe abdominal pain, infections, and on and on.  He wasn’t diagnosed properly until he was thirty—with Addison’s disease—at that time, 1946, a death sentence.  But, five years later, a new steroid pill arrived, which turned out to be the cure for most such patients, including JFK.

The author made a statement about JFK that bears repeating, “Kennedy deserves respect for all the suffering he endured, for his mere survival in the face of long odds—for his remarkable resilience.  Most normal people with half his medical problems and a fraction of his wealth would have retired to a quiet, easy life.”  “Like his hero Winston Churchill and his predecessor Franklin Roosevelt, John Kennedy never gave up.”

And now, an infamous historical figure, Adolf Hitler, who the author believes had a mental illness, most probably bipolar disorder which went untreated in any positive manner, but rather in a very destructive manner from 1936 onward.  This is the period Hitler did his most dastardly deeds—aggressive warfare and genocide.

Despite his political assassinations and grasp of power, the author states that Hitler’s “moderate bipolar disorder influenced his political career for the better—fueling his charisma, resilience, and political creativity.”  After 1937, “… the harmful effects of daily intravenous amphetamine—to which he was especially susceptible because of his bipolar disorder—worsened his manic and depressive episodes, impairing his leadership skills with catastrophic effects.”  As the author explains, “In his final two years, Hitler probably never experienced a day of normal mood.”

I encourage everyone to read this entire book to assess for yourselves the good and bad that can come from mood disorders in leadership and to determine for yourselves the author’s critique of “normal” leader failures in crisis times.  The chapter about Hitler contains details that reveal a depth of depravity caused by out-of-date remedies to bipolar disorder coupled with tragic and evil goals.

The author presents a good case for seeking extraordinary leaders for extraordinary times, such as Lincoln, Churchill, FDR and JFK.  But all these leaders had mental and/or physical weaknesses that are “weeded out” now.  When times are normal a “normal” leader can be good to help the trains run on time.  But in the Civil War, the Great Depression, World War II, the Cuban Missile Crisis and the Equal Rights Movement extraordinary leaders who have overcome huge physical and mental obstacles and possess energy and creativity, realism, empathy and resilience in depth can be the difference between success and failure on a grand scale.

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