'Madness' And Leadership, Hand In Hand

Originally published on August 22, 2011 9:48 am

If you think about the challenges facing the men and women running for president, you might think about travel, long hours, endless public scrutiny and complete erosion of privacy. The reward that waits after victory is more pressure: a huge weight of responsibility. It's hard not to wonder who would actually want that job.

Dr. Nassir Ghaemi, who runs the Mood Disorders Program at Tufts Medical Center in Boston, has an answer. In his new book, A First Rate Madness: Uncovering the Links Between Leadership and Mental Illness, Ghaemi lays out the argument that leaders with some mental illnesses, particularly mania or depression, are often better in times of crisis.

Ghaemi came to that conclusion after studying the lives and medical records of many great leaders, and found that quite a few — from Abraham Lincoln to Martin Luther King Jr. — had some form of mental illness.

"Historians have often not paid much attention to these features of their lives; they've just written them off as irrelevant to their leadership," Ghaemi tells NPR's Laura Sullivan. "So one thing I wanted to do was just to show that these symptoms not only were present in their lives, but were relevant to their leadership."

Ghaemi says a lot of research shows that there are some benefits to mania and depression.

"Creativity and resilience is higher in people with mania and realism and empathy is higher in people with depression compared to normal subjects," he says. "The problem often with mentally healthy, average leaders is — even though they're not weak in the sense of not having any of these qualities — they often don't have enough to meet the very high demands of crises."

Ghaemi explains that one of the reasons mentally healthy people might actually have a disadvantage when trying to navigate a crisis is that most of the time, the average person has what psychologists call a "mild positive illusion."

"We think that we're slightly more intelligent, slightly better looking, than we really are," Ghaemi says. "We tend to overestimate our control over our environment. And that can be quite fine under normal circumstances. That may actually help us to get more done because of that confidence, but a political leader needs to be realistic rather than just optimistic for the sake of optimism."

Ghaemi says his research revealed that both King and Mohandas Gandhi tried to kill themselves during adolescence, and that both suffered severe bouts of depression later in life.

"I went through the John F. Kennedy medical records in his archives — I believe I'm the first psychiatrist to do so," Ghaemi says. "His behaviors have been well known — his hypersexuality, his high energy — what I do is to go into the medical records and show how those symptoms really are consistent with this temperament called hyperthymic temperament in psychiatry, which means mild manic symptoms all the time. And then I base these diagnoses not just on these symptoms, but family history, because these illnesses are genetic."

The struggle with mental health that some people endure can take a toll, but some leaders — and Ghaemi's book counts the 35th president among them — emerge from that struggle more sure of themselves.

"In the case of Kennedy, I extensively describe his treatment with steroids, which worsened his manic symptoms. He was even treated with a neuroleptic, an anti-psychotic, when he was in the White House, for a period of depression," Ghaemi says.

As those drugs made his hyperthamic symptoms worse, he was a less successful as a leader.

"I think that was the case in the first year or two of his administration. Then his doctors got it under control," he says. "They basically forced him to stop using so many of those drugs ... and this correlates with the last year of his administration, when a lot of his policies changed remarkably and he became that major civil rights advocate, that very resilient Cold War leader who we now look back on and value very much."

Ghaemi says that Kennedy's mental illness — rather than being the thing he had to overcome on the path to success — may have been the crucial element in preparing him for the White House.

"The hyperthalmic temperament has been shown in studies to be the kind of personality that is most helpful in being able to withstand traumatic experiences like sexual abuse, war and not developing post-traumatic stress disorder symptoms," Ghaemi says. "And I think that's what kept him alive and kept him going during the 1940s and 1950s, whereas most of us wouldn't have even though about running for president. We would have just wanted to be alive when we faced all the severe illness that he had."

Other recent leaders seem to be closer to our definition of mental health. Ghaemi says that George W. Bush and Tony Blair, who were both in office during the terrorist attacks of Sept. 11, 2001, "have backgrounds that do not show any evidence of severe depression, severe mania or extreme personality traits. So there's no reason to claim that they have any mental illness; they're within the range of average mental health."

But that itself could be a handicap.

"One might examine how they dealt with the 9/11 crisis and whether they were realistic enough," Ghaemi says. "And whether their inability to be realistic about some things, such as weapons of mass destruction and that rationale for invading Iraq."

Ghaemi wonders whether President Obama, whom he points out has described himself as "well adjusted," might actually be "a little less normal than we've been led to believe."

"It's possible," Ghaemi says, "if we understand from his memoirs, that he dealt with a lot of identity crises personally and racially, which may have influenced his moods, his anxiety, his personality and made him much more nuanced than the average person might be."

If holding out hope that a president of the United States has at least a little bit of mental illness seems strange, Ghaemi says, he hopes his book helps to correct "a deep prejudice in our society."

"Many of us just believe that mental illness is inherently bad and mental health is inherently good," he says. "And the message from both the science and the history that I'm discussing here is that there's some good and some bad to both mental illness and mental health. I think the idea of a 'No Drama Obama,' of this very average, stable, healthy person, is a reflection ... of that stigma, of the idea that if there's any mental abnormality, it must be harmful. And in fact, if he has a little bit of drama to him, it might be quite helpful."

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

LAURA SULLIVAN, host: Ready for a pop quiz? Which of these influential leaders was mentally ill?

(SOUNDBITE OF ARCHIVED BROADCASTS)

Sir WINSTON CHURCHILL: We shall fight on the seas and oceans.

MARTIN LUTHER KING JR.: It is a dream deeply rooted in the American dream.

President JOHN F. KENNEDY: Ich bin ein Berliner.

(SOUNDBITE OF CROWD CHEERING)

SULLIVAN: The answer? All of them. Now, which of these leaders are mentally healthy?

(SOUNDBITE OF ARCHIVED BROADCASTS)

President BARACK OBAMA: So today I'm announcing that we're ramping up our efforts to get capital to small businesses in rural areas.

President RICHARD NIXON: I have never been a quitter.

President GEORGE W. BUSH: Let us increase the use of renewable power and emissions-free nuclear power. (SOUNDBITE OF APPLAUSE)

SULLIVAN: The answer again, all of them. That's according to the new book by psychiatrist Nassir Ghaemi. It's called "A First-Rate Madness: Confronting the Links Between Leadership and Mental Health." He says some of the world's greatest leaders have also suffered from mental illness - specifically, depression and certain types of mania. And he says that's no coincidence.

Dr. NASSIR GHAEMI: And there's a good deal of research that shows that there are some benefits to mania and depression, such as creativity and resilience is higher in people with mania, and realism and empathy is higher in people with depression, compared to normal subjects. The problem, often, with mentally healthy average leaders is, research shows that the normal population has a mild positive illusion, the psychologists call it. We think that we're slightly more intelligent, slightly better looking than we really are. We tend to overestimate our control over our environment. And that can be quite fine under normal circumstances. That may actually help us to get more done, because of that confidence. But a political leader needs to be able to be realistic rather than just optimistic for the sake of optimism.

SULLIVAN: You name a number of famous leaders in your book that people have some knowledge of as being depressed or mentally ill: Lincoln; some people may be aware of Gandhi, but also Martin Luther King; John F. Kennedy - why did he get placed as mentally ill?

GHAEMI: Well, some of the leaders that I describe have been understood to have had severe depression, at least, or even mania - like Lincoln, like Churchill. But historians have often not paid much attention to these features of their lives. They've just written them off as irrelevant to their leadership. So one thing I wanted to do was just to show that these symptoms not only were present in their lives, but were relevant to their leadership. And I tried to look back into their biographies and see what other historians may not have described as being related to depression or mania.

In the case of King and Gandhi, for instance, they both made suicide attempts in adolescence, and both King and Gandhi had severe depressions before they were killed. And in the case of John Kennedy, his behaviors have been well-known - his hypersexuality, his high energy and so on. What I do is to go into the medical records and show how those symptoms really are consistent with this temperament called hyperthymic temperament in psychiatry, which means mild manic symptoms all the time. And then I base these diagnoses not just on these symptoms but family history - 'cause these illnesses are genetic - the course of an illness - it starts in young adulthood; it has repeated episodes throughout life, in the case of bipolar disorder and treatment - and I go over their treatment histories.

In the case of Kennedy, I extensively describe his treatment with steroids, which worsened his manic symptoms. He was even treated with a neuroleptic, an anti-psychotic, when he was in the White House, for a period of depression.

SULLIVAN: Did that help him or hurt him?

GHAEMI: In that case, it helped him. But he also abused anabolic steroids through most of the 1950s. So when those drugs made his symptoms much more severe and worse, he was a much less-successful leader. I think that was the case in the first year or two of his administration. Then his doctors got it under control. They basically forced him to stop using so many of those drugs - and again, I document that. And this correlates with the last year of his administration, when a lot of his policies changed remarkably and he became that major civil rights advocate, that very resilient Cold War leader who we now look back on and value so much.

SULLIVAN: So was his ability to overcome all of those years of illness - that led to that resilience, is that what did it for him?

GHAEMI: Yes. The hyperthymic temperament has been shown in studies to be the kind of personality that is most helpful in being able to withstand traumatic experiences - like sexual abuse, war - and not develop post-traumatic stress disorder symptoms. And I think that's what kept him alive and kept him going through the 1940s and '50s, whereas I think most of us would not have even thought about running for president. We would have just wanted to be alive when we faced all the severe illness that he had.

SULLIVAN: You talk about George W. Bush and Barack Obama as two presidents who are mentally healthy, and you even put Tony Blair in that category. But you say that that could actually be a bad thing.

GHAEMI: Right. I think that there's a pattern here that seems to be relatively consistent, that when there are major crises like the Civil War, World War II, and it seems recently with 911, the leaders who we have who were mentally healthy, who have been successful before that time, don't seem to do so well. In the case of George W. Bush and Tony Blair, they have backgrounds that do not show any evidence of severe depression, severe mania or extreme personality traits. So there's no reason to claim that they have any mental illness. They're within the range of average mental health. And if we think about these traits of leadership, one might examine how they dealt with the 911 crisis and whether their inability to be realistic about some things, such as weapons of mass destruction and that rationale for invading Iraq, was perhaps due to their being average people.

And I think this is a reflection of the mild positive illusion, the mild optimism of normal mental health, which gets expanded when one reaches a position of great power, whereas if someone's a little depressed, that illusion isn't there to begin with, and then in a position of power, one might be able to be more realistic - like Lincoln was, like Churchill was.

SULLIVAN: How does Barack Obama figure into all this?

GHAEMI: Well, I think that Barack Obama has been presented to the public as being very mentally healthy and normal. He himself has used the phrase well-adjusted to describe himself. And this may be the case and if so, I think it will be a limitation to him, perhaps, in his leadership in these times of great crisis. It's possible that he's a little less normal than we've been led to believe, if we understand from his memoirs that he dealt with a lot of identity crisis personally and racially - which may have influenced his moods, his anxiety, his personality, and made him much more nuanced than the average person might be.

But I think that many of us just believe that mental illness is inherently bad, and mental health is inherently good. And the message from both the science and the history that I'm discussing here is that there's some good and some bad to both mental illness and mental health. You know, I think the idea of a no-drama Obama - of this very average, stable, healthy person - is a reflection, again, of that stigma, of the idea that if there's any mental abnormality, it must be harmful. And in fact, if he has a little bit of drama to him, it might be quite helpful.

SULLIVAN: Nassir Ghaemi is head of the Mood Disorders program at Tufts University. His new book is "A First Rate Madness: Uncovering the Link between Leadership and Mental Illness." He spoke to me from member station WCAI in Woods Hole, Massachusetts. Nassir Ghaemi, thank you.

GHAEMI: Thank you, Laura. Nice to be with you. Transcript provided by NPR, Copyright NPR.