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A First-Rate MadnessReview - A First-Rate Madness
Uncovering the Links Between Leadership and Mental Illness
by Nassir Ghaemi
Blackstone Audio, 2011
Review by Wendy C. Hamblet, Ph.D.
Jul 31st 2012 (Volume 16, Issue 31)

The subtitle of A First-Rate Madness, linking leadership with madness, suggests the book as a condemnatory study of the obvious historical culprits of genocide and other atrocities, from Hitler to Idi Amin. However, the opening chapters of the book confound the reader's simplistic expectations of a censure of mad leaders by launching its argument from the shocking assertion that the mentally healthy are less effective, and often dangerous, in positions of leadership during times of catastrophe, while the mentally ill may make the best crisis leaders. Nassir Ghaemi's "inverse law of sanity" sees the mentally ill leader as the best person for the job in one vital circumstance--in times of crisis. Following Cesare Lombroso (The Man of Genius, 1889) who equated genius with madness, on the argument that the genius was so far superior to the ordinary person that he could not be considered "normal" (contra the more popular view of Frances Galton, which equates sanity with intelligence and genius), Ghaemi proceeds to unfold the characteristic symptoms of the mental illnesses of depression and mania, and to locate evidence of these diseases in the details of the lives of a spectrum of historical leaders. The objective of this study is to unseat our simplistic understanding of the discrete categories of mental health and mental illness, to reveal the complexity of features associated with mental illnesses and to expose the positive qualities promoted by those who suffer and overcome mental illness.

Ghaemi, a scholar in the fields of history, philosophy and public health, is representative of a new breed of interdisciplinary scholar, laboring in the budding discipline of "psychological history," on the border between the fields of history and psychiatry. Ghaemi applies the evidentiary methods of psychiatry, "stripped of its psychoanalytic faith," to the case histories of dead leaders to demonstrate that many of history's heroic and villainous leaders suffered from mental illnesses, which greatly affected their characters, their political performances and their decision-making. Mental illnesses, explains Ghaemi, are diagnosed following four lines of evidence--symptoms (case studies including self-reports but also reports from friends and family members); genetics (family histories of mental illness); course of the illness (characteristic patterns of development over time); and response to treatments (a particular response to a drug suggesting a diagnosis of disease). This multi-evidentiary approach, argues Ghaemi, parallels the historian's method, which builds case studies of historical actors by reviewing a spectrum of documents, such as letters and other contemporary reports by family, friends and other observers.

Ghaemi's study begins from a reconsideration of what is meant by "mental illness." Concentrating on two of the most prevalent mental illnesses, depression and mania (commonly called bipolar or manic depression). Depression, the author explains, reveals itself in symptoms such as slow movement, low energy, declining interest in life and chronic fatigue or anxious pacing. The depressed are mired in the past and cannot break free from guilty or remorseful thoughts, and as a result, their lives are characterized by strings of broken relationships, high rates of divorce and alienation from loved ones, often resulting in suicide. In mania, the sufferer tends to be deliriously giddy or angry, talking fast, interrupting others and irritated by the slow pace of others.  Their self-esteem raises them up beyond all guilt or self-doubt, so they often make poor judgments, their thoughts having been set free from all perceived limits. They report flights of creativity, explosions of thoughts, like fireworks or a racing computer. Their focus is solely upon the future; the past is gone and the present has little claim on their attention or conscience. Both mania and depression are generally understood to render the sufferer out of touch with reality.

However, Ghaemi challenges these merely negative assessments of mental illness, explaining that these diseases have been extensively studied and are shown to promote four qualities that are critical during times of crisis--creativity, resilience, realism and empathy. Mania stimulates creativity and resilience, while depression cultivates all four critical features--creativity in seeking solutions to crises, resilience in the face of hardship, realism in assessing the seriousness of impending consequences (versus the prejudice that depressives are unduly negative and out of touch with reality), and empathy for suffering others.

Moreover, Ghaemi argues that too little scholarly attention has been afforded the overlap between the symptoms associated with mental illness and the features of the personality type known as hyperthymic personality (from the Ancient Greek ύπερ θυμός or over-spiritedness). In terms of the three parameters that psychologists employ for categorizing human minds--neuroticism; sociability; and openness to experience-- Ghaemi sees hyperthymics forming a unique class of effective crisis-leaders, having no trace of neuroticism, yet displaying extreme sociability (extravertedness, rich sensitivity to others, generosity, cheerfulness, uncommon warmth) and an extraordinary openness to experience (risk-taking courage, strong libido, dismissive of social norms and unusually productive), features often associated with mania and depression. However, it should be noted that hyperthymia, where it is discussed at all in serious professional psychological scholarship, is disputed as a simplistically understood, poorly defined mental trait best left to use by popular self-help authors.

On the other end of the mental health spectrum, Ghaemi places the typical mentally healthy leader--the bank president, ordinary national leader or corporate executive leader--and he delineates the shortcomings of these "normal" leaders. They tend to be privileged, idealistic, overly optimistic and generally insensitive to suffering, having never known suffering themselves. A perfectly adequate non-crisis leader, argues Ghaemi, the mentally healthy are fine in times of peace, but they can be ineffective and downright dangerous in times of crisis--underestimating the risks involved, lacking compassion for those who are suffering, disconnected from those outside his class and inconsistent and waffling when catastrophes strike. Moreover, the most "normal" people, incapable of realistically assessing risk, can easily become devout followers of dangerous dictators. Ghaemi uses the example of Nazi generals under Hitler, as well as the German masses, as "homoclites" who are easily swayed to atrocious acts by the charisma and exuberant energy of a manic depressive leader.

Ghaemi dissects the lives of U.S. Civil War leaders, prominent World War II leaders and finally national heroes and peace figures, such as John F. Kennedy, Martin Luther King and Mahatma Gandhi. His objective is to show probable evidence of mental illness in each of these heroes/villains, but also to break down the reader's neat categories of mental health and mental illness. Our ideas about "normalcy" in mental health are skewed, argues Ghaemi. "Normal" people tend to sacrifice realism in the interest of happiness, seeing themselves as happier than most other people, better off than they actually are, and less endangered by the risk factors of their lives. When dark realities do strike them, they tend to freeze, waffle, and rebound from trauma far less quickly than those who are deemed "abnormal." Mental health, Ghaemi explains, is better viewed as a spectrum of the qualities denoted as symptoms, rather than as discrete categories with opposite features. His "Goldilocks principle" suggests that those in the middle of the U-curve, having not too much and not too little, but just the right amount of these symptoms, fare best in confronting reality and navigating successfully through the tragedies of their lives. Most people have more or less severe forms of mental "illness," argues Ghaemi, such that in non-crises, their "illness" serves them poorly, causing them to look to others for support. But in crisis situations, our "illness" can help us thrive; we see the problem more realistically, step up to support those around us, and act decisively to change the situation. "Depressive realism" kicks in to replace the "positive illusions" that fool us into thinking we have more control over external events than we actually have; they warn us of the actual risks involved and help us to devise creative responses to deal with our difficulties.

One stunning upshot of Ghaemi's study is its implication for our view of those who have suffered and overcome mental illnesses: Ghaemi is convincing in his claim that people who have suffered through and overcome their mental illnesses, far from deserving the negative stigma generally attached to them in their societies, should instead be recognized as superior human beings, in many respects improved by their ill-health experiences. It seems Nietzsche is right: whatever does not kill us (or drive us to utter psychosis) makes us stronger, rendering us more resilient, compassionate, creative and shrewdly realistic. Like hardships such as poverty during childhood and other tragic experiences throughout life, mental illnesses can build our core skills for navigating the human condition and connecting with others. Painful episodes of mental illness are always periodic, so the breaks between the episodes, explains Ghaemi, allow time for intense self-reflection and reflection on the tragedies and contradictions of life, that are ultimately shared by all. Thus mental illnesses teach people how to survive difficult circumstances, they build resilience to future challenges and catastrophes, and they stretch our hearts to connect us with others. They teach us the existential equality of all persons, our common vulnerability to suffering.

Ghaemi's book is fascinating, well-written and carefully researched and accessible to any educated audience. The audio version is easily followed and serves well for passing the hours of a long car ride. The book's structure holds fast the reader's interest by maintaining a consistent pattern of alternating chapters detailing a diagnosis with meticulous mini-biographies of historical figures who exemplify the diagnosis. The historical evidence Ghaemi rallies to support his diagnosis is seamless, with few exceptions. The best feature of the study is the work it performs to upset our facile prejudices against the recovered mentally ill. Ghaemi insists on dismantling the discrete categories of mental health and mental illness, so the blurred borders between the two categories enable us to see more clearly that the very same qualities deemed symptoms of mental disease under peaceful historical conditions are identical to the features of genius we glorify in times of trouble. This common identity has a twofold upshot for the reader: it warns us against demonizing those who have suffered through mental illness, and it warns us of the risk of placing our unqualified trust in charismatic, high-spirited leaders during times of crisis, without taking great care to place adequate checks and balances on their actions.


© 2012 Wendy C. Hamblet,


Wendy C. Hamblet, Professor, North Carolina A&T State University


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