instagram pinterest linkedin facebook twitter goodreads

A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness

Praise for Nassir Ghaemi’s A FIRST-RATE MADNESS

“The book is a glistening psychological history, faceted largely by the biographies of eight famous leaders… A First-Rate Madness is carefully plotted and sensibly argued.” –Boston Globe

“[Ghaemi’s] book is a readable layman’s guide to depression, bipolar disorder and other ills, with colorful case histories and well-chosen quotes…a provocative thesis… Ghaemi’s book deserves high marks for original thinking.” –The Washington Post

“Ghaemi isn’t the first to claim that madness is a close relative of genius, or even the first to extend the idea into politics. But he does go further than others… His explanations are elegant, too—intuitively accurate and banked off the latest psychiatric research.” –Newsweek /

“On the surface, the thesis [of A First-Rate Madness] may seem counterintuitive. But Ghaemi provides exhaustive research and makes a compelling case for his point, which is perhaps best summed up by an aphorism from Martin Luther King, Jr.: ‘Human salvation lies in the hands of the creatively maladjusted.’” –Scientific American

“A First-Rate Madness is a sophisticated work of psychology, but it is also a gossipy work of celebrity history, a who’s who of the eminently unhinged.” –New York Observer

“[P]rovacative, fascinating.” –

“[I]nsightful and extraordinary… Recommended.” –Seattle Post-Intelligencer

“A First Rate Madness may have a daring and controversial thesis, yes, but it’s psychiatry and history are surprisingly first-rate and engaging.” –


"Plato said it first: We all have a degree of madness that can serve our creativity. Nassir Ghaemi has said it again in the language of psychiatry, in a book that is so well written and so full of engaging stories that you'll want to embrace his point of view. Dr. Ghaemi turns upside down our usual way of seeing. You will enjoy this challenging book and be thrown into wonder about the value of sanity and the perverse gifts of neurosis." —Thomas Moore, author of Care of the Soul and Care of the Soul in Medicine

"With brilliance and courage, Ghaemi explores the relationship of mental illness to creative leadership in times of crisis. He explains with great clarity the myriad meanings of mood disorder and other illnesses, and ties this analysis to compassionate historical discussions of many of the most—and least—successful major leaders of the past two hundred years. This is a first-rate book." —Michael Fellman, Professor Emeritus of History at Simon Fraser University; author of Citizen Sherman and In the Name of God and Country

"Nassir Ghaemi reinvents psychohistory as a serious form of scientific inquiry. Along the way, he presents a bounty of startling facts about some of history's great heroes and villains. Under his highly informed and skeptical gaze, our burnished icons—Lincoln and Sherman, Churchill and Hitler, Kennedy and Nixon, and others—are in for some serious resculpting." —Daniel Dennett, Professor of Philosophy at Tufts University; author of Breaking the Spell, Freedom Evolves, and Darwin's Dangerous Idea

"Considered together, and with such rigor and clarity as they are here, these stories are staggering. If so many leaders have suffered so hard, we may well ask: What is 'mental health' anyway? Certainly, we need to reconsider sentimental notions of greatness and heroism. With deft use of biographical and psychiatric detail, Ghaemi exposes a central current of human experience that badly needs this kind of careful and sensitive attention." —Joshua Wolf Shenk, author of Lincoln's Melancholy

"Nassir Ghamei's book is a provocative examination of the link between leadership, depression and mania. It will arouse enormous interest, together with anger and disagreement, and many people will want to read it." —Paul Johnson, author of Churchill, A History of the American People, and Modern Times

"No one who reads this brilliantly insightful book will ever look at history or politics the same way. Ghaemi uses his deep knowledge of medicine and psychiatry to take readers on a fascinating voyage into the minds of great leaders. His conclusions are startling, provocative, disturbing and deeply persuasive." —Stephen Kinzer, author of Reset, Overthrow and All the Shah's Men

Now available in paperback, summer 2012.

From the Penguin Press catalog, summer 2011:

"In A First-Rate Madness, Nassir Ghaemi, who runs the Mood Disorders Program at Tufts University Medical Center, draws from the careers and personal plights of such notable leaders as Lincoln, Churchill, Gandhi, Martin Luther King, Jr., JFK, and others from the past two centuries to build an argument at once controversial and compelling: the very qualities that mark those with mood disorders—realism, empathy, resilience, and creativity—also make for the best leaders in times of crisis. By combining astute analysis of the historical evidence with the latest psychiatric research, Ghaemi demonstrates how these qualities have produced brilliant leadership under the toughest circumstances.

Take realism, for instance: study after study has shown that those suffering depression are better than “normal” people at assessing current threats and predicting future outcomes. Looking at Lincoln and Churchill among others, Ghaemi shows how depressive realism helped these men tackle challenges both personal and national. Or consider creativity, a quality psychiatrists have studied extensively in relation to bipolar disorder.
A First-Rate Madness shows how mania inspired General Sherman and Ted Turner to design and execute their most creative—and successful—strategies.

Ghaemi’s thesis is both robust and expansive; he even explains why eminently sane men like Neville Chamberlain and George W. Bush made such poor leaders. Though sane people are better shepherds in good times, sanity can be a severe liability in moments of crisis. A lifetime without the cyclical torment of mood disorders, Ghaemi explains, can leave one ill equipped to endure dire straits. He also clarifies which kinds of insanity—like psychosis—make for despotism and ineptitude, sometimes on a grand scale.Ghaemi’s bold, authoritative analysis offers powerful new tools for determining who should lead us. But perhaps most profoundly, he encourages us to rethink our view of mental illness as a purely negative phenomenon. As A First-Rate Madness makes clear, the most common types of
insanity can confer vital benefits on individuals and society at large—however high the price for those who endure these illnesses."


"We remember Churchill the orator, the fiery leader, the man who refused to submit to tyranny, and in whose stubborn refusal a nation, and then the world, found the strength to resist and ultimately prevail. Other prominent British statesmen had failed to fill the role that Churchill rode to glory. Neville Chamberlain, a courtly conservative, had to step aside after his attempts to appease Hitler only spurred the dictator to greater acts of aggression. The contrast between Churchill and Chamberlain in their approaches to Hitler is well known. Where Churchill began to warn about Nazism as early as October 1930, Chamberlain remained oblivious as late as the fateful Munich visit in 1938. What made Churchill see the truth, where Chamberlain saw only illusion? I believe Churchill’s severe recurrent depressive episodes heightened his ability to be realistic about the threats that Germany posed. There is no doubt that Churchill had severe periods of depression; he was open about it—calling it his 'Black Dog.' Apparently his most severe period was in 1910, when he was, at about age thirty-five, home secretary. He later told his doctor, 'For two or three years the light faded from the picture. I did my work. I sat in the House of Commons, but black depression settled on me.'

A skeptical reader might argue that Churchill was just a pessimist who always imagined the worst; his negativism happened to be correct in the 1930s. Or one might think of him as an anomaly, an exception to the conventional wisdom that mental illness impairs leadership. Neither is the case.Numerous studies show that depression can make those who suffer from it more realistic than “normal” people. And Winston Churchill is hardly the only example of depressive realism shaping leadership. We can see this phenomenon playing out in a variety of circumstances. In the cases of Churchill and Lincoln (who also suffered from depression), it led to the realization that war was necessary. In the case of Mahatma Gandhi and Martin Luther King, Jr. (also depressives), it made them see the need to reject violence. It would be wrong to view realism as only a rationale for war, a logic for jingoism. Our greatest proponents of peace were also depressive realists."