In September 2001, I was working in Manhattan as an assistant director of a homeless shelter in which lived 200 men. Each had a psychotic illness. For two days after the 9/11 attacks I was unable to get into Manhattan, but I made it to work on Thursday, September 13, taking the bus over the George Washington Bridge. The city felt like a war zone. The acrid smell of smoke suffused the air; sirens and alarms sounded constantly; armed soldiers or police officers stood on every corner. I steeled myself, expecting the shelter to be, well, more insane than usual.
I was astonished to find everything at the shelter as it always was—if anything, a little calmer. When I asked the residents if they had any concerns, someone pointed out that the hot water was not working very well. No one mentioned the fact that a large portion of lower Manhattan was no longer there. At last I felt compelled to bring up the attacks. The men said they felt bad for those who had suffered, but all of that had happened a couple of days ago. At first I was indignant at their seeming apathy, but over time I realized that 9/11 was for many of them the day the level of crisis in the world met their own. Functioning in a crisis mode was something they knew how to do very well.
This phenomenon is more or less what Nassir Ghaemi adroitly explores in A First-Rate Madness. The book, though psychologically nuanced, has a simple thesis: Leaders who have mental illness or have experienced periods of mental abnormality are often better able to handle crises than their mentally healthy peers. When it comes to wars and depressions, it’s better to have someone at the helm who has suffered than someone who has not. In Ghaemi’s formulation, George W. Bush, a fairly untroubled soul once he got past his substance abuse, was ill equipped to handle 9/11. In his response to the tragedy, he was rigid, insufficiently empathic, and overly optimistic. Abraham Lincoln, depressed and tortured, would have done a lot better.
Ghaemi, a psychiatrist at Tufts University School of Medicine and author of a number of distinguished books on psychiatry, sees four potential derivatives of mental suffering: creativity, realism, empathy, and resilience. Mania, for example, is strongly associated with torrents of new ideas. People who have suffered from depression often see the world in more realistic and pragmatic terms than “normal” people, who have been shown in studies to be overly sanguine about the world and their place in it. Those who have suffered any illness tend to be more empathic, understanding that life is fragile and difficult. And those who can survive mental illness (and there’s the rub) learn skills of resilience that are applicable to any of life’s hardships.
Through a series of deft and highly perceptive case histories, Ghaemi explores how figures including Lincoln, Civil War general William Tecumseh Sherman, media mogul Ted Turner, British prime minister Winston Churchill, father of Indian independence Mahatma Gandhi, civil rights leader Martin Luther King Jr., and Presidents Franklin Delano Roosevelt and John F. Kennedy, all of whom either suffered from mental illness or sustained periods of mental abnormality, brought special attributes to the crises of their times and ultimately became great leaders and innovators. (The pool of female political leaders from which to draw is admittedly small, but the fact that Ghaemi’s sample does not include a woman is a shortcoming.)
Ghaemi’s thesis is a provocative one, and like a lot of ideas that push our cultural narrative forward, it simultaneously holds water and does not. A First-Rate Madness is at its most convincing in its analyses of individuals whose depression (Lincoln, Churchill) or bipolar disorder (Sherman, Turner) was either self-admitted or, based on the historical record and personal diaries, indisputable. While Lincoln and Churchill lived in a largely preclinical age, one cannot read their writings about the depths of their periodic suicidal states and not be absolutely convinced that they suffered from major depression for most of their lives. These were men who stared into the abyss early and often, and thus were able to take wars and secessions in stride. For these great figures, as for my men in the shelter, crisis was normal, and they were able to retain the ability to function.
The novelist Walker Percy, a major depressive himself, wrote of the phenomenon of the ex-suicide: the person who almost kills himself but chooses not to. Take a man waiting for the bus on a March day in the rain, Percy said. Life is dull, annoying, and vaguely painful. Take that same man waiting for the bus, having just escaped his own suicide: Life is an unexpected gift, profound and joyous. Everything is gravy—he had not expected to be alive. Lincoln and Churchill were ex-suicides many times over. “I don’t like standing near the edge of a platform when an express train is passing through,” Churchill told his doctor. “A second’s action would end everything.” Having survived chronic inner anguish, Lincoln and Churchill found the battles at Gettysburg and on the Normandy beaches relatively manageable.
The chapters on Kennedy and Roosevelt are less persuasive. Ghaemi argues that FDR and JFK were mentally abnormal—that at the very least, they suffered from hypomania (a mood state characterized by loquacity, an excess of energy, an inordinate need for sex, and general recklessness). Though Kennedy’s sexual voracity was indeed abnormal, it seems to me that both his and Roosevelt’s abnormalities were more physical (Roosevelt’s polio, Kennedy’s severe Addison’s disease) than mental. Roosevelt’s struggle with the physical impairments of polio led him to become more empathic and less of a rich, arrogant dandy. Kennedy’s enormous resilience seems more a reflection of his personality and his unbridled ambition than a product of his mental state.
Nonetheless, A First-Rate Madness has important implications for public policy and how we view the stigma of mental illness. Perhaps we should be more tolerant of our leaders’ foibles, indiscretions, weaknesses, diagnoses, and, yes, psychiatric histories. In Bush and Barack Obama, we’ve had stable, “mentally healthy” presidents who arguably have not been particularly adept at managing crises. I have no doubt that someone who had faced the abyss would have done a better job of leading the country as it faced a decade of abysses.
Ghaemi makes clear from the outset that his troubled but great leaders are best for times of crisis, not tranquility. When peace and prosperity reign, he writes, “mental health is useful. One meets the expectations of one’s community, and one is rewarded for doing so.” Yet in reading A First-Rate Madness I kept thinking of Dwight Eisenhower, a figure absent from its pages. As a military commander Eisenhower functioned on the brink in World War II and on D-Day, and as president he led the country during the relatively placid 1950s. He had his flaws, and he may not have been flashily creative or intellectual. But as a victorious general he was humane, he was profoundly realistic (warning us of the dangers of the evolving military-industrial complex), and he was enormously resilient. Yet Eisenhower, I submit, was about as sane as any man who ever lived, or at least as sane as anybody who ever wished to be president. Perhaps the true value of Ghaemi’s book is that it shows how diverse the wellsprings of leadership are, from the fervor of madness to staid and prosaic sanity.
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Charles Barber, a lecturer in psychiatry at Yale Medical School, is the author of Comfortably Numb: How Psychiatry Is Medicating a Nation (2008). He is currently writing a novel about a depressed detective.
Reviewed: A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness by Nassir Ghaemi, Penguin, 2012, 340 pp.
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