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

I know it looks like a creepy book—the Frankenstein’s monster effect of combining three portraits of Lincoln, Franklin Roosevelt and John F. Kennedy doesn’t help. Even Nassir Ghaemi’s premise at first read seems chilling: some of the best leaders in the western world suffered from mental illness, and at times were completely incapacitated by their maladies.  However, Ghaemi’s compelling and well-argued thesis is that “the best crisis leaders are either mentally ill or mentally abnormal…[and] the worst crisis leaders are mentally healthy.”

This is a scientific yet highly readable book, adeptly written by Dr. Ghaemi, an expert in the field of mood disorders.  When I say expert, I mean, he is the Director of the Mood Disorder Program and the Psychopharmacology Consultation Clinic at Tufts Medical Center and a professor at Tufts University School of Medicine.

Just to set up Ghaemi’s approach, he uses the term “madness” very loosely, almost with a note of sarcasm for the term. Most of the men (as they all are) suffered from forms of depression; either straight-up classic depression, bipolar disorder or what Ghaemi calls “hyperthymia” or a personality type that errs on the side of manic. In most cases, the subject is deceased and Ghaemi is gathering evidence from his four-part assessment: symptoms, genetics, course of illness and treatment. Using his subject's personal correspondence to family and friends and finding evidence that relatives also suffered similar sounding maladies, helps to contribute to his post-mortem diagnosis.

Ghaemi starts with depression. In this category he includes General William T. Sherman (American Civil War), Winston Churchill and Abraham Lincoln. All three men came to power in times of great crisis, specifically war. All three men had episodes of depression during their lifetimes that completely debilitated them, but who had gained other qualities like empathy, resilience and “depressive realism”. They could press through the difficult times without knowing the outcome, and subsequently lead others to do the same.  People spoke of Lincoln’s “gravitas”, Sherman’s empathetic savagery, and Churchill’s unwavering spirit in the face of adversity. Ghaemi makes a good argument that their depression forged this way for them.

As evidenced by the cover, he includes FDR and JFK in his mentally unhealthy categories because of two reasons: both men suffered from lifelong chronic illnesses, both had hyperthymic personalities--all energy and drive (including sex drive) and little downtime. JKF also was misdiagnosed for much of his life and as a result had peculiar treatments for his Addison’s Disease. In this illness, the adrenal glands do not produce steroids, which compromises the immune system. So JFK was on multiple steroids and was frequently fighting massive infections. He apparently took amphetamines and barbiturates as well. Somehow, his doctors managed to get Kennedy to an acceptable balance much of the time.

Not the case with Adolf Hitler. Hitler suffered from bipolar disorder and was on increasingly bizarre combinations of drugs to keep him on the manic side of his disorder. By the end of the war, Hitler was on steroids, amphetamines, barbiturates, narcotics and while experiencing mood swings that seemed to range only between depressive and manic, with no relief between.

Ghaemi makes a strong case for mentally stability for Richard Nixon, George W. Bush and Tony Blair, which proved how their normality was their downfall in times of crisis.

The epilogue is one of the most satisfying chapters. Ghaemi writes it like an academic essay, allowing detractors of psychological history to give their case and he to refute. I can’t say I’m on board with every one of his historical assessments but he really does build a strong case. Dr. Ghaemi does not feel that mental illnesses should be hidden, maligned or seen as shameful and this book is proof. He cites Aristotle in the author’s note and it is very apt:

“Why is it that all those who have become above average either in philosophy, politics, poetry or the arts seem to be melancholy?”