PDF Summary:A First Rate Madness, by Nassir Ghaemi

Many of us consider good mental health to be an important quality for leaders, whether they’re a nation’s president, a military general, or a CEO. However, in A First-Rate Madness, psychiatrist Nassir Ghaemi argues that mental illness can make leaders better fit to lead during crises and that mental illness contributed to the successes of historical leaders such as Winston Churchill and Franklin D. Roosevelt. According to Ghaemi, if we better understand how conditions like depression and bipolar disorder can enhance leadership, we can lessen the cultural stigma surrounding mental illness.

In this guide, we’ll define mental health and explore how abnormal mental health has influenced successful leadership decisions during critical times of war and conflict. Finally, we’ll uncover the pitfalls of being a mentally well leader and how mental health treatment affects leadership. Along the way, we’ll compare Ghaemi’s arguments to those of other mental health experts and provide additional historical context.

(continued)...

(Shortform note: In Emotional Intelligence, Daniel Goleman writes that the amount of empathy you have depends on how you were nurtured during your childhood. Around age two and a half, toddlers begin to recognize pain experienced by others and not just their own. Parents who explain their feelings help their children become more aware of emotions in themselves and others, thereby increasing empathy. At the same time, while having a lot of mirror neurons helps you empathize with others, they can also make you unhappy if you’re overly sensitive to other people’s negative emotions.)

Ghaemi points to studies that link depression to higher empathy, particularly on an emotional level. He explains that depressive episodes leave you with a lingering sensitivity to other people’s experiences and allow you to better relate to them. This empathy ultimately allows you to understand multiple viewpoints, which is a key leadership trait.

(Shortform note: While depression can lead to increased feelings of empathy, it can also lead people to misunderstand some of those empathetic feelings. This can cause people with depression to experience empathetic distress, or feelings of guilt for other people’s negative feelings. They explain that people with depression are often sensitive to other people’s emotions yet have an inaccurate understanding of what causes their emotions. For example, a person with depression might notice irritability in their colleague’s tone while collaborating on a difficult project and think they’re annoyed with them instead of the project. This misunderstanding of causality can lead people with depression to experience more personal guilt and distress.)

Example: Mahatma Gandhi, Martin Luther King, and Nonviolent Activism

According to Ghaemi, depression heightened the empathy of Mahatma Gandhi and Martin Luther King Jr., helping them pioneer and advance nonviolent activism. Although sometimes dismissed as naive optimism, this form of resistance didn’t equate to passive acceptance, but instead centered on being firm and uncooperative without resorting to violence.

(Shortform note: One study found that nonviolent movements tend to be more successful than violent movements. After examining 323 movements against authoritarian governments, researchers determined that nonviolent movements—even those that failed—made a country four times more likely to transition to democracy. Successful nonviolent resistance movements benefited from mass participation and flexible strategies while those that failed lacked organization.)

Ghaemi argues that Gandhi’s depression is evident from some events in his early life—he had attempted suicide as a teenager and experienced depressive episodes throughout his life. Ghaemi argues that Gandhi’s struggles with this illness gave him the necessary empathy to cultivate his nonviolent approach to campaigning for India’s independence from British rule, encouraging his followers to understand their enemy’s perspective.

(Shortform note: Although Susan Cain doesn’t address Gandhi’s depression, in Quiet, she identifies similar traits of Gandhi’s personality as crucial to his success: his shyness and restraint in the face of conflict. She argues that he demonstrated soft power—the ability to win people over through gentle persistence and compelling beliefs rather than violence or threats. Rather than fight back, he steadily worked toward his goal through passive disobedience. His ability to practice this restraint, Ghaemi might argue, came about because of his depressive empathy.)

Similarly, Martin Luther King Jr. had attempted suicide in his youth and experienced depressive episodes, and his leadership of the civil rights movement, through nonviolent resistance, was affected by these experiences. In the face of injustice, King called for his followers to “love your enemies” and try to share their perspectives in order to change their minds.

(Shortform note: As Ghaemi points out, even though King opposed the actions and beliefs of his opponents, he still sought to understand them. In this way, King might have been practicing what Chris Voss, in Never Split the Difference, refers to as tactical empathy—trying to understand someone’s emotions to get what you want from them. To do this, Voss suggests you practice active listening, adopt an encouraging tone, repeat back the other person’s words, validate their emotions, and anticipate their concerns.)

Ghaemi points out, however, that violent and aggressive tactics took over in both movements. The empathy of nonviolent activism was difficult to maintain for the masses of people who were largely unchallenged by mental illness. Gandhi and King were only able to commit to this empathy-driven activism because of their struggles with depression.

(Shortform note: Ghaemi argues that nonviolence is hard to maintain because most people lack the heightened empathy of those who’ve struggled with mental illness. In The Laws of Human Nature, Robert Greene offers an additional explanation for our difficulty in avoiding violence: Aggression is part of human nature, and the more helpless we feel, the more aggressive we get. Social movements are rife with feelings of helplessness as people advocate for change, which might explain why they can so easily erupt into violence.)

How Mania Prepares Leaders for Unprecedented Challenges

Now that we’ve examined how depression enhances leadership, let’s discuss how mania can help leaders not only understand critical situations, but also overcome them. According to Ghaemi, mania and hyperthymia can make a leader uniquely prepared to tackle unprecedented challenges by boosting their resilience to adversity and encouraging innovative thinking.

1) Mania Enhances Your Ability to Overcome Adversity

Ghaemi contends that mania can enhance your ability to overcome adversity because it naturally elevates your mood and energy while decreasing anxiousness and self-doubt. This also applies to people with hyperthymic personalities who naturally have positive traits such as a sense of humor, enthusiasm, and open-mindedness, all of which combine to make a leader more capable of handling trying circumstances.

(Shortform note: While Ghaemi believes mania can help you overcome adversity and thus become more resilient, others have found that people with bipolar disorder often have lower levels of resilience. Whether or not you struggle with mental health issues, Brené Brown offers suggestions on how to improve your ability to overcome adversity. In The Gifts of Imperfection, she advises you to develop a hopeful way of thinking, challenge harmful social expectations, acknowledge your negative feelings, and practice spirituality.)

Additionally, beyond just mania, mental illness prepares leaders to overcome difficult challenges because mental illness is, itself, challenging to deal with. Struggling with any illness—whether physical or mental—can make you stronger and help you to overcome future hardships. In other words, a moderate amount of adversity makes you psychologically healthier than if you experience no adversity at all.

(Shortform note: In The Happiness Hypothesis, Jonathan Haidt argues that the timing of adverse experiences matters—experiencing difficulties at certain stages in your life can make you more resilient than when you experience them at other times. In particular, when you overcome adversity during your teenage and young adulthood years, you gain the most personal growth because you experience many important life changes then and tend to reflect on those years more.)

Example: Franklin D. Roosevelt, Polio, and the Great Depression

According to Ghaemi, Franklin Delano Roosevelt’s hyperthymic personality coupled with his battle with polio improved his resilience to adversity, allowing him to become an effective president during the Great Depression as well as World War II.

(Shortform note: During the two crises, Roosevelt found an innovative way to help the American people become more resilient themselves. He started the Fireside Chats, which was a series of around 30 radio speeches he made to the American public. During these broadcasts, he spoke informally, as though he were personally conversing with people by their fireplaces. By talking transparently about topics ranging from unemployment to US involvement in World War II, Roosevelt reassured and raised the confidence of Americans.)

Roosevelt showed many classic signs of having a hyperthymic personality: He was energetic, witty, and highly sociable. However, at age 39 he contracted polio, which left him paralyzed from the waist down. Yet despite his physical disability, Roosevelt was able to persevere in his political career because of his hyperthymic personality. According to Ghaemi, Roosevelt’s manic tendencies helped him grow psychologically stronger as he battled polio, leaving him wiser and more prepared to guide the nation through the economic depression and subsequent war.

(Shortform note: Like Ghaemi, Doris Kearns Goodwin argues in Leadership in Turbulent Times that Roosevelt’s battle with polio improved his leadership abilities. However, while Ghaemi focuses on his ability to overcome adversity, Goodwin contends that Roosevelt’s contracting of polio allowed him to develop the necessary empathy to gain the trust of the American people and collaborate with his team to establish agencies and projects that would restore the nation’s economy.)

2) Mania Improves Innovative Thinking

In addition to helping leaders overcome adversity, mania can enhance a leader’s creativity, allowing them to generate innovative solutions to unprecedented challenges. Ghaemi defines creativity as the ability to both come up with inventive solutions and detect key problems that others fail to notice.

(Shortform note: While mania may help those with manic depression or hyperthymia generate more creative solutions, there are ways you can actively cultivate more creativity in your life. In the Little Red Book of Selling, Jeffrey Gitomer says you must first believe in your potential to generate creative ideas to be in an innovative state of mind. He suggests you further develop your creativity by creating a stimulating workspace, being open to failure, and getting in the habit of writing down ideas.)

According to Ghaemi, symptoms of mania promote divergent and complex thinking, making people more aware of nuances that encourage new insights. This enhanced creativity allows leaders to break free from traditional approaches and to generate new solutions, both important when navigating unprecedented conflicts. Ghaemi argues that mentally well leaders, on the other hand, tend to be more confined to conventional strategies that are reliable for peacetime politics but disadvantageous during crises.

(Shortform note: The idea that mania directly results in increased creativity is still debated. In a group of bipolar patients, one study found that only 8% of them could be considered highly creative. However, other studies suggest at least a correlation between bipolar disorder and creativity that hints at a causal link. Studies have found an overrepresentation of bipolar disorder in creative occupations compared with the general population. Researchers suggest one reason why mania may enhance creativity: Mania causes your brain to release higher levels of dopamine, which allows you to take in more stimuli from your surroundings and thereby enhances your ability to think creatively.)

Example: General Sherman and the Civil War

In the 1860s, the American Civil War tested the leadership of Union Army General William T. Sherman. Ghaemi contends that General Sherman likely suffered from bipolar disorder, which gave him the innovative thinking skills needed to invent a new strategy of war that was instrumental to securing the Union victory.

Drawing from reports of the time, Ghaemi concludes that Sherman likely suffered from episodes of mania and depression. Ghaemi argues that these episodes allowed him to look beyond the traditional warfare tactics that involved direct confrontations between two armies. Instead, he realized the need to alter his approach, launching an innovative “total war” campaign to march through the South and target the region’s land and resources, resulting in the scorched-earth “March to the Sea” he’s remembered for.

Sherman’s March: An Attack on Confederate Morale

Like Ghaemi, many historians consider Sherman a visionary military commander for his time, arguing that his approach during his March to the Sea resembled the warfare that would be conducted nearly a century later during the 20th-century world wars. One reason Sherman's approach was so revolutionary was that it was psychological. Rather than aim to defeat the Confederates solely through battlefield combat, Sherman sought to bring an end to the war by destroying their morale.

His approach differed from how the Union had been waging war thus far—the Union fought a limited war that left Confederate property and enslaved people unharmed. During Sherman’s march through Georgia, however, he directly targeted public property and military resources to deplete Confederate morale, yet he still avoided direct attacks on civilians and their individual homes. It was this innovative thinking that Ghaemi pegs as a product of his bipolar disorder.

How Mental Wellness and Treatment Affect Leadership

Ghaemi not only explains how mental illness can foster positive leadership traits, but he also details the specific ways that mental health can contribute to leadership failures. In addition, he argues that the manner in which you treat mental illness can affect leadership abilities—proper treatment can enhance positive traits while improper treatment can impair crisis decision-making.

Good Mental Health Is Bad During Crises

According to Ghaemi, mentally healthy leaders often make bad decisions during crises—they tend to be overly optimistic, less empathetic, unchallenged by struggles, and inflexible when compared to mentally ill leaders. He argues that while such leaders can be effective during peacetime, they often lack the right instincts during times of conflict. To make his point, he examines how mental health negatively affected the leadership of Neville Chamberlain, George McClellan, George W. Bush, and Tony Blair.

Emotions, Memory, and Decision-Making During Crises

Ghaemi describes several reasons why mentally healthy people make bad decisions in crises. However, everyone, regardless of their mental health, can fall prey to poor decision-making because of how our brains use memory to make those decisions. Experts explain that, when making decisions, our brains look for patterns when we assess situations, and we often react to those patterns based on our memories or past experiences. These reactions can be misleading because our memories have emotional tags—emotions that are attached to a memory, such as the joy of success or the distress of failure.

Even the most perceptive leader can’t always tell when they’re being influenced by these emotions, which can cause them to overlook certain factors while focusing on others. For this reason, experts believe that group decision-making is the best practice for making crucial decisions.

Ghaemi argues that the reason Neville Chamberlain, the prime minister preceding Winston Churchill, was unable to accurately assess the threat Hitler posed to the world was that Chamberlain was too mentally stable. Unlike Churchill, Chamberlain took a more conciliatory approach to the Nazi threat. Ghaemi argues that Chamberlain’s mental health prevented him from understanding the reality of the situation—that appeasement wouldn’t be an effective solution. Instead, the Prime Minister was overly optimistic, dismissed the German dictator’s belligerent intentions, and believed that war could be avoided through negotiation.

(Shortform note: In 1938, during Neville Chamberlain’s three-year term as prime minister, Hitler had already annexed Austria and set his eyes upon Sudetenland, a German-speaking region of Czechoslovakia. In September, Chamberlain met with the German dictator and signed the Munich Agreement, granting him Sudetenland so that he wouldn’t invade Czechoslovakia. When Chamberlain returned, he announced the success of the agreement in a speech: “I believe it is peace for our time.” This statement, Ghaemi might argue, reflects his optimistic and unrealistic view of the situation, for in a matter of months, Hitler would take over the rest of Czechoslovakia and march into Poland.)

Similarly, Ghaemi argues that the sound mental health of General George B. McClellan, another Union commander during the Civil War, contributed to his military failures. Unlike with General Sherman, Ghaemi found no evidence that General McClellan suffered from any mental illnesses, and this prevented him from having bold, creative insights. McClellan consistently misjudged his enemies and limited himself to the traditional strategies he’d learned at West Point. His good mental health limited his ability to think outside the box and made him inflexible.

Did General McClellan Have a Messiah Complex?

Historians propose an additional factor that might have contributed to General McClellan’s military failures: He suffered from an inflated ego. He believed he was chosen by divine providence to be the savior of the Union and reveled in his nickname “Young Napoleon.” However, while he confidently organized and trained his men for long periods of time, he consistently hesitated when it came time for battle, overestimated the size of enemy forces, and withheld his troops.

Some historians have suggested that McClellan did have some form of psychological abnormality, namely a “messiah complex,” which is sometimes associated with bipolar disorder. Others, however, maintain that McClellan’s belief that he was chosen by God to perform his work was normal for a time when religion played a big part in people’s lives.

On the whole, this debate reinforces the notion that mental health is on a spectrum yet also suggests that not all traits of mental illnesses are beneficial to leadership, such as the grandiosity some may experience with bipolar disorder.

Finally, Ghaemi examines the leadership of George W. Bush and Tony Blair during the September 11 attacks in 2001, arguing that neither leader possessed the understanding or flexibility to properly handle the situation. Based on a review of their pasts, Ghaemi determines both Bush and Blair to be mentally healthy. He argues that both failed to approach the conflict with a nuanced perspective and decided to use military power to invade Iraq, a controversial decision that many have criticized.

(Shortform note: Historian Melvyn P. Leffler offers deeper insights into the driving forces behind Bush’s decision to invade Iraq. He argues that three factors drove Bush’s decision: fear, power, and hubris. Leffler contends that Bush feared another attack and wanted to demonstrate the power of the US military. When no weapons of mass destruction were found, Bush shifted his focus to bringing democracy to Iraq, believing that everyone wanted to live by American values. This inflexibility, Ghaemi might argue, is a classic sign of Bush’s hubris syndrome.)

How Proper and Improper Mental Health Treatment Affects Leadership

According to Ghaemi, the treatment of mental health also affects leadership—proper treatment can improve leadership while improper treatment can negatively impact leadership abilities. To explain how, Ghaemi takes us through the medical history of John F. Kennedy and Adolf Hitler.

(Shortform note: In his review of the effects of mental health treatment, Ghaemi focuses primarily on the drugs used to treat historical leaders in the early to mid-20th century. However, today, there are numerous methods for treating mental illnesses beyond medication, such as counseling sessions with a licensed psychologist, support groups, and creative or active therapies such as art or yoga. With a wide variety of treatments available, it has become easier to receive proper care to manage mental illnesses.)

According to Ghaemi, President John F. Kennedy and Adolf Hitler shared two notable similarities as leaders: Both had manic tendencies and both were treated with drugs that altered their mental states. While Kennedy successfully guided the US away from nuclear war thanks to his hyperthymic personality, Hitler set into motion a costly war that resulted in mass death and destruction.

For the first half of his presidency, doctors treated Kennedy with four kinds of steroids daily, which drastically altered his mood and impaired his ability to lead. However, by the early 1960s, they cut back on his steroid use, better managing the treatment of his mental illness. This proper treatment, Ghaemi argues, enhanced Kennedy’s positive manic traits (such as his high energy and resilience), contributing to his leadership successes during the second half of his presidency.

Specifically, these treatments allowed him to act appropriately when Soviet leader Nikita Khrushchev brought nuclear missiles to Cuba. Rather than limit himself solely to the black-and-white options of military action or inaction like Bush or Blair later would, Kennedy chose to establish a naval blockade that successfully led to Khrushchev withdrawing the missiles and avoided warfare.

In contrast, the improper treatment of Hitler’s bipolar disorder with amphetamines severely impaired his ability to lead. Before his abuse of drugs, Ghaemi argues, Hitler possessed many of the same positive leadership qualities associated with bipolar disorder such as the creativity of mania and the realistic judgment of depression. His abuse of amphetamines in 1937, however, exacerbated his illness, leading him to make extreme and aggressive military decisions that catapulted the world into World War II.

Drug Abuse and Leadership in the 20th Century

Ghaemi focuses on how drugs used to treat John F. Kennedy’s and Adolf Hitler’s mental illnesses affected their leadership. But experts note that it wasn’t only drugs for mental illness that affected leadership in the 20th century: Many political leaders of that era (not just those with mental illness) used or abused drugs that were prescribed for other ailments, and these similarly affected how they responded to crisis situations.

Leaders often used drugs first because, since they were in positions of power, they had easy access to them, and second because people knew little about the negative effects of many drug treatments at the time. This made many leaders susceptible to another illness with harmful effects on their leadership abilities: addiction.

Although Ghaemi doesn’t focus on Winston Churchill’s use of drugs, other experts point out that Churchill became so dependent on drugs and alcohol during his final year in office that he could no longer participate in decision-making. Similarly, Churchill’s successor, Anthony Eden, navigated the Suez Crisis disastrously, in the eyes of many, while addicted to amphetamines.

According to experts, amphetamine abuse spread among elite groups around the mid-20th century as a result of “celebrity doctors” (doctors who became famous for treating celebrities). While, initially, amphetamines can increase alertness and energy, continued use can create a sense of grandiosity, loss of emotional regulation, increased impulsivity, and other impairments to leadership and decision-making abilities.

Some historians believe that the German celebrity doctor Max Jacobson gave Kennedy regular amphetamine injections, although there aren’t any medical records that can confirm this theory. In Hitler’s case, experts believe that his doctor, Theodor Morell, gave the German dictator over 70 medications. From 1944 onward, Hitler took daily tablets containing caffeine and a form of amphetamine, along with cocaine.