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Book Review: A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness by Nassir Ghaemi

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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 Nassir Ghaemi photoof 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)

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About ToddT

I enjoy baseball and writing about it. I pay to see independent league play, the Fort Worth Cats and the Grand Prairie AirHogs, and I follow the Texas Rangers rather passionately. A native of the Dallas area, I am nearing 60 years old, and I have been married to my college sweetheart for 36 years and counting.
  • Frank

    How often are these same people responsible for creating the crisis in the first place.

  • Todd Thompson

    Frank, that question is not addressed directly. Ghaemi uses historical events to support his thesis, most of which have complex causes which evolve over a period of years.