- - Monday, October 24, 2011


By Nassir Ghaemi
Penguin Press, $27.95, 352 pages

Dr. Nassir Ghaemi is a professor of psychiatry at Tufts University who serves also on the faculty of the Harvard Medical School and holds degrees in history, philosophy and public health. He would seem well-equipped to explore the effects of mental illness on leadership abilities, and that he has done in a thoughtful and readable way.

In “A First-Rate Madness,” he employs a case-study approach, using outstanding figures from history to illustrate how bipolar mentality can disable or enhance the ability of leaders to cope with crisis. His subjects are William T. Sherman, Ted Turner, Winston Churchill, Abraham Lincoln, Mahatma Gandhi, Martin Luther King Jr., Franklin D. Roosevelt, John F. Kennedy and Adolf Hitler. In each of these cases, there was early history of mood swings, some dominated by depression, others by ebullient, thymic personality (FDR in particular).

Kennedy had Addison’s disease, the absence of an adrenal gland function, and took massive doses of prednisone and anabolic steroids for “maniclike enhancement” until Dr. George G. Burkley took over as his physician well into JFK’s presidential term. Kennedy’s urologist wrote: “John F. Kennedy experienced a profound psychochemical influence for the better in a spectacular way. This is not an uncommon clinical phenomenon.”

Hitler also made long and excessive use of amphetamines, which brought about progressive irrationality in decision making. In the case of Sherman, stress brought on a severe breakdown from which the patient bounced back with spectacular energy, activity and indomitability and with an original military strategy that greatly hastened the Union victory.

Hitler’s case is interesting. His parents were cousins, so signs of mental illness in the family were aggravated by inbreeding. While Hitler always showed signs of bipolar personality, it was not until 1937 that he began heavy intravenous use of amphetamines, particularly when depressed, as after the Battle of Stalingrad. His source, one Dr. Theodor Morell, kept close and secretive control of the medication. Hitler’s behavior became increasingly unpredictable until he became a psychochemical disaster. A few generals tried to persuade psychiatrists to order Hitler’s commitment to an institution but without success.

The thesis of “A First-Rate Madness” is sharpened by contrasting some leaders who maintained even temperaments and rose to great success in normal times, only to fall short when crisis struck, not only failing to meet the problem but not recognizing the dimensions or even the presence of the problem. To this category are assigned Gen. George B. McClellan and Neville Chamberlain, among others.

The first two exemplify what my boarding school contemporaries used to call the “senior prefect type,” meaning someone who followed all the rules, kept out of trouble, did a good routine job, hewed to the governing conventions, was free from controversy and infractions of discipline, a “Mr. Perfect.”

The comparisons make entertaining reading and the author’s command of history is convincing. In dealing with Sherman’s devastating nervous breakdown and dramatic recovery, Dr. Ghaemi recalls that Gen. Henry Halleck and Lincoln were inclined to relieve Sherman of command, but Ulysses S. Grant would have none of it, recalling Sherman’s decisive contribution at Shiloh. Later Sherman recalled: “Sam [Grant] stood up for me when I was crazy, and I stood up for him when he was drunk.”

Churchill had severe bouts of depression (he called it “the black dog”), particularly starting in 1910 when he was home secretary and lasting two or three years. Later, his wartime chief of staff, Gen. Hastings Ismay, said of Churchill: “He’s either on the crest of the wave or in the trough … when he isn’t fast asleep he’s a volcano,” a cyclothymic personality (related to bipolar disorder). He was noted for his high energy and huge work output, even into his old age.

Franklin Roosevelt also had the hyperthymic personality, one that impressed Justice Oliver Wendell Holmes Jr. in 1933 when he said of FDR: “He has a second rate mind, but a first rate temperament.”

Dr. Ghaemi’s book is far from an exercise in superficial psychohistory. He has researched the medical histories of his subjects and has interspersed his individual case studies with detailed discussions of the science and treatment of hyperthymic and bipolar personalities. The writing style is fluid and vivid, the personalities brought to life. The thesis of his book gave me a new way of looking at depressive and manic swings and at leadership. Put briefly, manic-depressive and hyperthymic traits are likely to enable one to think and act “outside the box,” for good or ill.

David C. Acheson is a former president of the Atlantic Council of the United States.

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