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

In this book Ghaemi puts forward an hypothesis that he calls The Inverse Law of Sanity.  According to him most of our leaders are exceedingly sane men such as Neville Chamberlain who in times of normality perform well.  However in times of crisis display such people demonstrate lacklustre leadership.  Instead in such times the best leaders are those with mood disorders.  Ghaemi argues his case using such leaders as Abraham Lincoln, Gen. William T. Sherman, Winston Churchill, Mohandas Gandhi, Franklin D. Roosevelt, John F. Kennedy, Dr. Martin Luther King, Jr., and Ted Turner among others.  In particular Ghaemi contends these leaders owe much of their success because they were suffering some form of Bipolar Personality Disorder, either the full blown disorder itself or some milder variant such as hyperthymia (mild mania), dysthymia (mild depression), or cyclothymia (alternating between lows and highs in mood and energy.

The core of mania is impulsivity with heightened energy. Increased levels of mania usually mean creativity and sociability but if it is too pronounced it can lead to irritability, promiscuous sexuality, and lavish spending (eg Kennedy and Roosevelt).  On the other hand according to Ghaemi depressed people are not depressed because they distort reality; they are depressed because they see reality more clearly than other people do.  Depressed people also have more empathy, resilience and creativity.  I can agree with empathy but with regard to resilience I beg to differ.  It is people with low levels of the Depressive component in their personality who have high resilence.  Also it is mania that leads to creativity (the flight of ideas) not depression.

As someone who promotes the Humm-Wadsworth model of temperament this was a compelling book to read.  Temperament is how your genetic make-up defines how you react emotionally.  The Humm-Wadsworth says that your reactions are determined on where you fall in the spectrum of the seven most common mental illnesses.  It is here that I have difficulty with the book.  Ghaemi appears to see everything through the lens of Manic-Depression.  

Kretschmer was the first person to define the Cyclothymic (ie Manic-Depressive) mental disorder but he also defined another disorder, the Schizothymic (or Autistic-Paranoid).  Surely the one characteristic of all leaders is high levels of paranoia.  Andy Grove said it best in his eponymous book: Only the Paranoid Survive.  I find it difficult to accept Ghaemi’s thesis that Nixon was a homoclite or a person or with normal behaviour.  Like all successful politicians Nixon was well to right of the Paranoid spectrum with an overpowering desire to compete and win.  His downfall could be attributed to a severe paranoia for chasing demons that maybe did not exist and resorting to tactics that were not necessary.

On the other hand I found many of the biographies very interesting and discovered much.  Non USA citizens in particular will learn a lot about the USA reading this book.  Ghaemi himself was born in Iran and moved to the USA when he was five years old.  Dr. Ghaemi is a world-class psychiatrist; and is one of the world’s experts on issues of mood disorder so his emphasis on Manic-Depression is understandable.  No matter how hard we try, avoiding confirmation bias is almost impossible.