Book Review: "A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness" by Nassir Ghaemi, M.D.

The Penguin Press (2011), $27.95 (hardcover)

By Bob Carolla, NAMI Director of Media Relations

One of the best books to document and discuss in detail the link between mental illness—specifically depression—and great leadership is Lincoln's Melancholy by Joshua Wolf Shenk. Dr. Ghaemi, the director of the Mood Disorders Program at Tufts University, now takes the discussion of mental illness and leaders further by including bipolar disorder and expanding the scope to several other historical and contemporary leaders, including Civil War general William Sherman, Winston Churchill and Ted Turner. Also included are Mahatma Gandhi and Martin Luther King, whose names are new to "famous people" lists that provide inspiration to many people who live with mental illness.

The book makes the case that four elements are essential to leadership in times of crisis: realism, empathy, creativity and resilience. Living with depression can enhance the first two traits and mania can enrich the third. Both can help instill resiliency. At the same time, some conditions such as psychosis can prove disastrous.

Leadership can be exercised for good or evil— independent from mental illness. In other words, free will and moral values remain part of the equation. The book includes a chilling discussion of Adolf Hitler, who presided as the leader of Germany during World War II and the Holocaust; Ghaemi makes a case that Hitler lived with untreated bipolar disorder which gave him charisma, resilience and political creativity in his rise to power. On the other hand, by the time the war began, he was being treated with barbiturates and amphetamines (including meth) for insomnia and fatigue, a combination that only worsened his mental illness. Essentially, his mind spun out of control—possibly into some form of psychosis. In that respect, impairment of his leadership abilities because of heavy drug use was a stroke of good fortune for civilization. “In his final two years, Hitler probably never experienced a day of normal mood,” Ghaemi writes. “His world was collapsing; his mind already had.”

The book also includes discussion of other leaders such as John F. Kennedy, Richard Nixon and George W. Bush, arguing that “homoclite” leaders who “want to be liked” can be dangerous in times of crisis. “Normal” mental health may actually be a drawback. This section, as well a chapter on stigma and politics, are not the books strongest but they raise issues that are worth thinking about carefully. Would our country ever elect a president who acknowledges living with bipolar disorder—and perhaps even campaigns on it as a qualification suited for the times? In some cases, personal experience with mental illness may be a strength, providing vision and a foundation for brilliant leadership, but the stigma surrounding mental illness still prevents a completely open discussion.

Posted at NAMI Advocate. NAMI Bookshelf August 2011. http://www.nami.org/ADVTemplate.cfm?Section=20111&Template=/ContentManagement/ContentDisplay.cfm&ContentID=126353

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