A First-Rate Madness Read online

  Table of Contents

  Title Page

  Copyright Page

  Dedication

  Epigraph

  Introduction

  PART ONE - CREATIVITY

  CHAPTER 1 - MAKE THEM FEAR AND DREAD US

  CHAPTER 2 - WORK LIKE HELL—AND ADVERTISE

  PART TWO - REALISM

  CHAPTER 3 - HEADS I WIN, TAILS IT’S CHANCE

  CHAPTER 4 - OUT OF THE WILDERNESS

  CHAPTER 5 - BOTH READ THE SAME BIBLE

  PART THREE - EMPATHY

  CHAPTER 6 - MIRROR NEURON ON THE WALL

  CHAPTER 7 - THE WOES OF MAHATMAS

  CHAPTER 8 - PSYCHIATRY FOR THE AMERICAN SOUL

  PART FOUR - RESILIENCE

  CHAPTER 9 - STRONGER

  CHAPTER 10 - A FIRST-RATE TEMPERAMENT

  CHAPTER 11 - SICKNESS IN CAMELOT

  PART FIVE - TREATMENT

  CHAPTER 12 - A SPECTACULAR PSYCHOCHEMICAL SUCCESS

  CHAPTER 13 - HITLER AMOK

  PART SIX - MENTAL HEALTH

  CHAPTER 14 - HOMOCLITE LEADERS

  CHAPTER 15 - STIGMA AND POLITICS

  EPILOGUE

  Acknowledgements

  NOTES

  BIBLIOGRAPHY

  INDEX

  THE PENGUIN PRESS

  Published by the Penguin Group

  Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014, U.S.A. •

  Penguin Group (Canada), 90 Eglinton Avenue East, Suite 700, Toronto, Ontario, Canada M4P 2Y3

  (a division of Pearson Penguin Canada Inc.) • Penguin Books Ltd, 80 Strand, London WC2R 0RL,

  England • Penguin Ireland, 25 St. Stephen’s Green, Dublin 2, Ireland (a division of Penguin Books

  Ltd) • Penguin Books Australia Ltd, 250 Camberwell Road, Camberwell, Victoria 3124, Australia

  (a division of Pearson Australia Group Pty Ltd) • Penguin Books India Pvt Ltd, 11 Community

  Centre, Panchsheel Park, New Delhi—110 017, India • Penguin Group (NZ), 67 Apollo Drive,

  Rosedale, Auckland 0632, New Zealand (a division of Pearson New Zealand Ltd) • Penguin Books

  (South Africa) (Pty) Ltd, 24 Sturdee Avenue, Rosebank, Johannesburg 2196, South Africa

  Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England

  First published in 2011 by The Penguin Press, a member of Penguin Group (USA) Inc.

  Copyright © Nassir Ghaemi, 2011

  All rights reserved

  Grateful acknowledgment is made for permission to reprint an excerpt from “Home After Three

  Months Away” from Collected Poems by Robert Lowell. Copyright © 2003 by Harriet Lowell and

  Sheridan Lowell.

  Excerpt from Aristotle’s Problemata from “The Paradox of Genius and Madness: Seneca and His

  Influence” by Anna Lydia Motto and John R. Clark, Cuadernos de Filología Clásica (Editorial

  Complutense, Madrid, 1992).

  Excerpt from On the Road by Jack Kerouac (Penguin Books). Copyright © Jack Kerouac, 1955, 1957.

  Library of Congress Cataloging-in-Publication Data

  ISBN : 978-1-101-51759-8

  1. Depressed person—Psychology. 2. Depression, Mental. 3. Leadership—

  Psychological aspects. I. Title.

  [DNLM: 1. Mentally Ill Persons—psychology. 2. Mood Disorders. 3. Leadership.

  4. Temperament. WM 171]

  RC537.G

  303.3’4019—dc22

  Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.

  The scanning, uploading, and distribution of this book via the Internet or via any other means without the permission of the publisher is illegal and punishable by law. Please purchase only authorized electronic editions and do not participate in or encourage electronic piracy of copyrightable materials. Your support of the author’s rights is appreciated.

  http://us.penguingroup.com

  To my father, Kamal Ghaemi, MD,

  and my mother, Guity Kamali Ghaemi,

  and for

  Heather, Valentine, and Zane

  Why is it that all those who have become above average either in philosophy, politics, poetry or the arts seem to be melancholy, and some to such an extent that they are even seized by the diseases of black bile?

  —Aristotle, Problemata, section XXX

  The only people for me are the mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones who never yawn or say a commonplace thing, but burn, burn, burn.

  —Jack Kerouac, On the Road

  INTRODUCTION

  THE INVERSE LAW OF SANITY

  “Genl Wm T Sherman Insane” ran the headline of the November 1861 Cincinnati Chronicle. General William Tecumseh Sherman had gone “stark mad” and been removed from Union command in Kentucky; his peers, family, and staff all agreed that he suffered from paranoid delusions. On his way home to Ohio, Sherman said with a shrug, “In these times it is hard to say who are sane and who are insane.”

  He would reclaim his commission and go on to become a symbol of the Civil War’s horror and a spokesman for psychological terror—the man history remembers for decimating Atlanta and scorching a trail through Georgia on his devastating “March to the Sea.” He is an iconic figure in American history, yet few Americans know about an essential aspect of the man whose “scorched earth” strategy informed modern warfare from London, Dresden, and the Battle of the Bulge to Vietnam, Bosnia, and Iraq.

  Historical evidence suggests that Sherman suffered from manic-depressive illness, or bipolar disorder—extreme shifts in a person’s mood, energy, and ability to function. Someone need have only one manic episode to be diagnosed as manic-depressive; in fact, most people with the illness suffer mostly from depression. In addition to the Kentucky breakdown, Sherman apparently had at least four other major depressive episodes, the first at age twenty-seven, with symptoms of hopelessness, inertia, insomnia, and loss of appetite. He’d been having trouble settling into a military career and feeling excessively controlled by his father-in-law. The second episode occurred around age thirty-seven, when Sherman was a struggling banker. Another followed a few years later, again involving financial hardship. Another, at age fifty-eight, thirteen years after the war, came after his oldest son, Tom, a deeply depressed and sometimes homeless man who ultimately died in an institution, refused to study law, as Sherman desired, and decided instead to become a Jesuit priest. (A paternal uncle of Sherman’s also likely suffered from recurrent depression, a genetic link that supports this diagnosis.)

  Sherman never admitted to a mental illness. In his Memoirs, published in 1875, he famously blamed others for his mistakes and finessed all questions about his mental health. Historians indulged his charitable self-image for more than a century. Only in 1995, with the work of historian Michael Fellman, were Sherman’s moods more thoroughly documented. Retrospective psychiatric diagnosis is fraught with risk and never definitive. Yet this doesn’t mean we shouldn’t follow the documentary trail and, in Sherman’s case, consider the likelihood that a man who caused so much suffering, suffered much himself.

  MOST OF US make a basic and reasonable assumption about sanity: we think it produces good results, and we believe insanity is a problem. This book argues that in at least one vitally important circumstance insanity produces good results and sanity is a problem. In times of crisis, we are better off being led by mentally ill leader
s than by mentally normal ones.

  There are different kinds of leadership for different contexts. The non-crisis leader succeeds in ordinary times, but in times of crisis should be kept far away from the scepter of rule. As we’ll see, the typical non-crisis leader is idealistic, a bit too optimistic about the world and himself; he is insensitive to suffering, having not suffered much himself. Often he comes from a privileged background and has not been tested by adversity; he thinks himself better than others and fails to see what he has in common with them. His past has served him well, and he seeks to preserve it; he doesn’t acclimate well to novelty. We see the non-crisis leader all around us—the CEO, the department chief, your neighbor’s boss, the bank president, the president. One more fact: he is quite mentally healthy. He has never suffered from depression or mania or psychosis. He has never seen a psychiatrist.

  ARISTOTLE FIRST SPECULATED about the link between genius and madness twenty-five hundred years ago, and at the height of the Romantic era the nineteenth-century Italian psychiatrist Cesare Lombroso defined that link forcefully, which we might translate as a simple equation: insanity = genius. He believed you can’t have one without the other. In contrast, the statistician and founder of behavioral genetics, Francis Galton, took the opposing view, which we can summarize as: sanity = genius. Galton argued that intelligence—the strongest indicator of a healthy brain—produced genius. Both men saw genius as biological in origin, but one believed it arose from illness, the other from health.

  These two views have seeped into Western culture, with most of us reflexively preferring Galton over Lombroso. In this book, I take Lombroso’s side, with some qualifications. Throughout I trace a basic law that emerges from studying the relation of mental illness to leadership. One might call it the Inverse Law of Sanity: when times are good, when peace reigns, and the ship of state only needs to sail straight, mentally healthy people function well as our leaders. When our world is in tumult, mentally ill leaders function best.

  Four key elements of some mental illnesses—mania and depression—appear to promote crisis leadership: realism, resilience, empathy, and creativity. These aren’t just loosely defined character traits; they have specific psychiatric meanings, and have been extensively studied scientifically. I use these terms in their scientific, not their commonsense, meanings. Among these qualities, psychologists have studied creativity and empathy most, but resilience and realism are just as important for leadership and have also been examined in some detail by recent researchers. Of these four elements, all accompany depression, and two (creativity and resilience) can be found in manic illness. Except for resilience, none are specific for other mental illnesses (like schizophrenia and anxiety disorders). Depression makes leaders more realistic and empathic, and mania makes them more creative and resilient. Depression can occur by itself, and can provide some of these benefits. When it occurs along with mania—bipolar disorder—even more leadership skills can ensue. In this book, I’ll examine eight great political, military, and business leaders whose lives and work show various aspects of the link between leadership and madness: William Tecumseh Sherman, Ted Turner, Winston Churchill, Abraham Lincoln, Mahatma Gandhi, Martin Luther King Jr., Franklin D. Roosevelt, and John F. Kennedy. I also provide counterexamples of five mentally healthy “normal” leaders who failed in moments of crisis: Richard Nixon, George McClellan, Neville Chamberlain, and possibly George W. Bush and Tony Blair. These counterexamples are important: I am not just diagnosing illness everywhere; I see mental health in most of our leaders, and I see it as a potential impediment in times of crisis.

  In the course of my research, it became clear to me that mental illness was even more influential in historical terms than I had first imagined. Several major Civil War leaders were mentally ill or abnormal: Lincoln and Sherman, as will be shown later, but also Ulysses S. Grant, the alcoholic; possibly Stonewall Jackson; even, according to some evidence of depression and a family history of mental illness, Robert E. Lee. All the major leaders of World War II can be shown, with reasonable evidence, to have been mentally ill or abnormal: Churchill, FDR, and Hitler, as we will see; as well as Stalin and Mussolini, each of whom had severe depressive episodes and probable manic episodes. Two key figures in the American civil rights movement, John Kennedy and Martin Luther King, were also mentally abnormal.

  I believe these examples are more than coincidence, and more than a historical oddity. They suggest a relatively consistent pattern that, if true, has been largely ignored by historians and the public, but that may have in fact shaped the second half of the twentieth century more than any other single force. Once we start to see history through this lens, the reach and import of madness and leadership become hard to deny.

  THIS IS A BOOK of psychology and of history; it sits at the long-disputed intersection of two different disciplines. But this book is not psychohistory. Psychohistory is a discredited discipline, and with reason. One need only read the book that started it all, written by the founder himself, Sigmund Freud’s Woodrow Wilson, cowritten with the American politician (and one of Freud’s patients) William Bullitt. There one finds passages like this:

  [Wilson] carried great burdens during the war for a man whose arteries were in precarious condition; and, although he continued to be troubled as usual by nervous indigestion and sick headaches, he suffered no “breakdown.” His Super-Ego, his Narcissism, his activity toward his father, his passivity to his father, and his reaction-formation against his passivity to his father were all provided with supremely satisfactory outlets by the war.

  No wonder historians are allergic to psychological interpretation. The book was so weak psychologically that Freud’s daughter and his closest disciples suppressed its publication, and when it finally appeared in 1967, they tried to argue that Freud wrote very little of it. For many historians, psychiatry and psychology are synonymous with psychoanalysis, and any psychological interpretation seems bound to end up in fruitless speculation about the early childhood traumas of historical figures. Indeed, until recently historians were correct. Psychiatry and psychology, in the United States, have long been infatuated with psychoanalysis. Only in the last two decades has psychoanalysis been put in its proper place—not simply discarded, but no longer seen as necessary and sufficient in itself. (Imagine if all of economics was thought to be contained in Marxism; psychiatry was that dependent on psychoanalysis until recently.)

  This psychoanalytic obsession has been replaced by a perspective on mental illness that is scientifically and medically sound. This psychiatry, stripped of its psychoanalytic faith, can be an extremely useful tool for historians.

  THE NEW PSYCHIATRY begins where modern medicine began, with the search for objective ways to diagnose illness. In internal medicine, doctors get a “case history”—a story of signs and symptoms and their course over time. Psychiatrists and historians do the same. Yet the internist has one resource that that historians and psychiatrists do not: pathology. Physicians have long disagreed with each other; one could diagnose a patient with a certain illness, and another could offer a quite different diagnosis, even given the same case history. But medicine changed dramatically when the pathologist could take a piece of tissue and determine which doctor’s diagnosis was right. The doctors would discuss the case in an auditorium, with students watching, each providing a rationale for a diagnosis. At the end of an hour’s debate, the pathologist would stand up, put a slide under a microscope, and reveal the right answer.

  Sometimes other tests are done: an analysis of blood chemistry, or an MRI scan of an organ. Yet sometimes these tests don’t give a definitive answer; sometimes tests can even be wrong. And good doctors know that tests help us get to the right answer by adding to the evidence gathered in the case history; alone they are hardly foolproof ways to diagnose illness. Of course, tests for physical conditions are often conclusive, but the problem with psychiatry—and with history—is that there’s no conclusive test. One can’t prove that a patient has schizop
hrenia with a blood test or a brain scan; and if this is true with a living patient sitting in front of me, it is obviously so with a dead historical figure.

  Yet medicine has long faced and solved this problem. Many illnesses outside of psychiatry can only be examined based on the case history—migraine, for example, and rheumatoid arthritis, and many forms of epilepsy. In these cases, doctors are in the same boat as are those who study mental illness—there’s no definitive test. The solution comes from the field of clinical epidemiology, the same discipline that teased out the link between cigarette smoking and lung cancer. When there’s no single proof, the solution is to obtain several independent sources of evidence. No single source is enough to prove a diagnosis, but all of them can converge to make a diagnosis likely.

  Four specific lines of evidence have become standard in psychiatry: symptoms, genetics, course of illness, and treatment.

  Symptoms are the most obvious source of evidence: most of us focus only on this evidence. Was Lincoln sad? That symptom could suggest depression, but of course one could be sad for other reasons. Symptoms are often nonspecific and thus not definitive by themselves.

  Genetics are key to diagnosing mental illness, because the more severe conditions—manic-depressive illness in particular—run in families. Studies of identical twins show that bipolar disorder is about 85 percent genetic, and depression is about half genetic (The other half, in the case of depression, is environmental, which is why this source of evidence is also not enough on its own.)