S. Nassir Ghaemi

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

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."

EXCERPT:

"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."

Selected Works

History/Psychiatry/Psychology
NEW: A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness
An investigation into the surprisingly deep correlation between mental illness and successful leadership, as seen through some of history’s greatest politicians, generals, and businesspeople
What psychiatry is all about
The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry
Published 2009: A sequel and successor to The Concepts, the first book length critique of the BPS model
The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness
Published 2003: A comprehensive survey of psychiatric thinking
Clinical psychiatry
A Clinician's Guide to Statistics and Epidemiology in Mental Health: Measuring Truth and Uncertainty
Published 2009: Accessible and clinically relevant, this book describes statistical concepts in plain English with minimal mathematical content. Perfect for the busy health professional, or the educated patient, who wants to know which statistics to believe - and why.
Mood Disorders: A Practical Guide, Second Edition
Second edition published 2008. A clinical handbook about the diagnosis and treatment of depression and bipolar disorder
Bipolar Depression
Published 2006: The first edited book of scholarly articles devoted to bipolar depression in English
Polypharmacy in Psychiatry
Published 2002: The only book-length treatment of this topic, this is an edited book about the use of multiple medications together in psychiatric conditions