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The New York Times bestseller“A glistening psychological history, faceted largely by the biographies of eight famous leaders . . .” —The Boston Globe“A provocative thesis . . . Ghaemi’s book deserves high marks for original thinking.” —The Washington Post“Provocative, fascinating.” —Salon.comHistorians have long puzzled over the apparent mental instability of great and terrible leaders alike: Napoleon, Lincoln, Churchill, Hitler, and others. In A First-Rate Madness, Nassir Ghaemi, director of the Mood Disorders Program at Tufts Medical Center, offers a myth-shattering exploration of the powerful connections between mental illness and leadership and sets forth a controversial, compelling thesis: The very qualities that mark those with mood disorders also make for the best leaders in times of crisis. From the importance of Lincoln's "depressive realism" to the lackluster leadership of exceedingly sane men as Neville Chamberlain, A First-Rate Madness overturns many of our most cherished perceptions about greatness and the mind.
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The op-ed columnist Maureen Dowd (born in 1952) published “Trump’s Crazy Fantasy World” in the New York Times (dated March 7, 2020). In it, she previews the American journalist Jonathan Karl’s forthcoming aptly titled new 368-page book, Front Row at the Trump Show. No doubt we should think of Donald J. Trump (born in 1946) as a showman putting on a show for journalists like Jonathan Karl (born in 1968) – so that he (Trump) can see himself covered in the news media.According to Maureen Dowd, here’s Jonathan Karl’s big scoop: When Mick Mulvaney (born in 1967) became President Trump’s acting chief of staff (a position he no longer holds), he urged senior White House staffers at a weekend retreat at Camp David to read Nassir Ghaemi’s 2011 book A Fist-Rate Madness: Uncovering the Link Between Leadership and Mental Illness. Dr. Nassir Ghaemi, M.D., is an Iranian American professor of psychiatry at Tufts University School of Medicine and the director of the mood disorders program at Tufts Medical Center in Boston.Ghaemi’s superficial and, at times, glib book is somewhat similar, in certain respects, to two books published in 2005: (1) The Hypomanic Edge: The Link Between (a Little) Craziness and (a Lot of) Success in America by John D. Gartner, Ph.D. (New York: Simon & Schuster) and (2) American Mania: When More Is Not Enough by Peter C. Whybrow, M.D. (New York: W. W. Norton).Ghaemi does not mention either book about Americans – or any of the other books in which authors use psychological concepts to discuss historical figures, except for Freud’s posthumously published co-authored work about Woodrow Wilson. As a matter of fact, Ghaemi is critical of all psychoanalytic approaches and of cognitive-behavioral approaches to depression (because they fail to recognize what he refers to as depressive realism – which he contrasts with the delusion of optimism).The prefix “hypo” is Gartner’s term hypomanic means less than full-blown manic. Ghaemi uses the term hypomanic to mean mild or low-level manic symptoms (pages 61 and 140). He also refers to mild depression symptoms (page 61). But a full-blown manic episode involves a psychotic break from reality. However, even regularly sustained hypomanic tendencies such as those discussed by both Gartner and Whybrow do not necessarily signal the onset of a full-blown hypomanic episode.Similarly, mild depression symptoms such as seasonal affective disorder do not necessarily signal the onset of full-blown clinical depression. However, recurring mild depression symptoms such as seasonal affective disorder as well as recurring mild manic symptoms may signal what Ghaemi refers to as a cyclothymia personality, which I discuss below.But what exactly are we supposed to learn from the examples of Americans discussed by Gartner and by Whybrow who manifested certain persistent but low-level manic tendencies, but who evidently never experienced a full-blown hypomanic episode? For example, are we supposed to learn just how elastic certain mental-illness terminology is?Now, even though Ghaemi does superficially discuss certain Americans in detail, including President Abraham Lincoln, President Franklin D. Roosevelt, President John F. Kennedy, and the Reverend Dr. Martin Luther King, Jr., Ghaemi also superficially discusses Winston Churchill, Adolf Hitler, and Mahatmas Gandhi. However, like Gartner and Whybrow, Ghaemi also does not claim that any of his examples experienced a full-blown hypomanic episode – a psychotic break with reality. So what exactly are we supposed to learn from the examples discussed by Ghaemi? Evidently, we are supposed to learn how well-known mentally ill leaders are different from mentally normal leaders, some of whom are also discussed by Ghaemi.No doubt Mick Mulvaney’s recommendation of Ghaemi’s 2011 book to senior White House officials hinged on Ghaemi’s glib characterizations that they might readily apply to characterize President Donald J. Trump. As a loyal member of Team Trump, Mick Mulvaney would want to arm senior White House staffers with Ghaemi’s weaponized psychiatric terminology in defense of Trump – whose critics often resort to their own use of weaponized psychiatric terminology to characterize and criticize him. In this way, perhaps the combative Mick Mulvaney wanted senior White House officials to fight fire with fire, and Ghaemi may have seemed to Mick Mulvaney to provide Trump’s apologists and defenders with a certain psychiatric fire-power they could appropriate and perhaps use. Or at least use silently in their own minds to resist the psychologized criticisms of Trump.In Ghaemi’s “Introduction: The Inverse Law of Sanity” (pages 1-19), he sets forth what he himself refers to as the Inverse Law of Sanity: “[W]hen 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” (page 3).But was the obviously mentally ill Trump with his persistent mildly manic symptoms elected president in 2016 because peace did not reign, eh? Or was he elected in 2016 because he was an effective salesman selling a delusion of optimism – the delusion that Ghaemi explicitly and emphatically associates with the mentally healthy? In Trump’s case, his delusional optimism may be his primary way of building up his resilience.The American salesman’s tragic propensity for the delusion of optimism is commemorated in the American playwright Arthur Miller’s famous 1949 play Death of a Salesman. Arguably the tragic sense of life of what Ghaemi refers to as depressive realism is expressed in the Irish playwright and novelist Samuel Beckett’s 1953 play Waiting for Godot.Ghaemi argues that the mental illnesses of mania and depression appear to promote four key elements involved in crisis leadership: (1) realism, (2) resilience, (3) empathy, and (4) creativity.But Trump famously lacks realism – rather he lives in an alternative reality. Perhaps Trump could claim a certain creativity in filing for bankruptcy – and a certain resilience in bouncing back from bankruptcy. But how is Mick Mulvaney going to persuade us about Trump’s empathy – by his bromance with thugs like Putin? But hold on – perhaps Ghaemi says something else that Mick Mulvaney picked up on.Ghaemi says, “First and most important, mental illness doesn’t mean that one is simply insane, out of touch with reality, psychotic. The most common mental disorders usually have nothing to with thinking at all, but rather abnormal moods: depression and mania. These moods aren’t constant. People with manic-depressive illness aren’t always manic or depressed. Thus they aren’t always insane; in fact, they’re usually sane. Their illness is the susceptibility to mania or depression, not the fact of actually (or always) being manic or depressed. This is important because they [such people] may benefit as leaders not just directly from entering and leaving those mood states, from the alternation between being ill and being well” (pages 10-11; his emphases).As far as I know, Trump has never been clinically depressed. As a matter of fact, he may not have ever experienced what Ghaemi describes as mild depression. Nevertheless, Trump may regularly alternate between what Ghaemi describes as mild manic symptoms and what he describes as the delusional optimism of mentally healthy people—as I explain below.But could Trump manifest certain mild manic tendencies, as do (or did) the Americans that Gartner and Whybrow discuss, without ever experiencing a full-blown hypomanic episode – a psychotic break with reality? Yes, this could happen.Ghaemi describes clinical depression as characterized by “anger and despondency” (page 12). He also characterizes full-blown mania as characterized by “impulsivity” (page 12). In addition, he says, “The core of [full-blown] mania is impulsivity with heightened energy” (page 15; his emphasis).Ghaemi says, “Some people are neither depressed nor manic, but they aren’t mentally healthy either. They have abnormal personalities or temperaments. . . . [M]any leaders, though not manic-depressive, have abnormal temperaments that are mild versions of manic-depressive illness” (page 15; his emphases).According to Ghaemi, “Most studies on personality identify at least three basic traits common to all people: [1] neuroticism, [2] extraversion, and [3] openness to experience. One of these [personality] traits is anxiety – we’re all more or less anxious (neuroticism) Another [personality trait] is sociability – some of us are more extraverted, some more introverted (extraversion). Another [personality trait] is experience seeking – some of us are curious and take risks, others are more cautious (openness to experience. We each have more or less of these [personality] traits, and, with well-designed psychological tests, one can establish how they’re distributed among thousands of normal people. One can then know where any single person stands on each [personality] trait, near the middle of a normal [bell-shaped distribution] curve – and thus near the average – or toward the extremes” (page 16).Just as Ghaemi focuses on three personality traits, so too he works with three specific personality types. He says, “These [personality] traits can combine to form specific personality types. [1] Some people are always a little depressed, low in energy, need more than eight hours’ sleep a night, and introverted. This personality type is called dysthymia. [2] Other people are the opposite: always upbeat, outgoing, high in energy. They need less than eight hours’ sleep a night and have more libido than most of us. This [personality] type is called hyperthymia, and it occurs often in great leaders, like Franklin Roosevelt and John F. Kennedy. [3] And some people are a little of both, alternating between lows and highs in mood and energy. This [personality] type is called cyclothymia” (page 16; his emphases).Like FDR and JFK, Trump appears to be characterized by what Ghaemi refers to here as hyperthymia. (The prefix hyper- means more than. Like Gartner and Whybrow, Ghaemi is silent about women and mild manic symptoms. In addition, he is silent about women and dysthymia and cyclothymia. In my estimate, former secretary of state Hillary Rodham Clinton did not and does not manifest hyperthymia – nor do any of the women who entered the 2020 Democratic primary.)However, unlike FDR and JFK, Trump appears not to have ever suffered deeply or to have experienced any significant depressive episodes in his life.By way of digression, I want to point out here that both Plato and Aristotle use the Greek word that can be transliterated as thumos or thymos to refer to one part of the human psyche (or soul) – the root word in the psychiatric terminology about dysthymia, hyperthymia, and cyclothymia. Whoever coined these psychiatric terms not only knew ancient Greek, but also knew how Plato and Aristotle discuss this part of the human psyche. For Plato and Aristotle, this part of the human psyche can be likened to a spirited horse that needs to be cultivated and tamed by the virtue of courage, which they operationally defined as the mean between the extremes of pusillanimity (cowardice) and brashness. For Plato and Aristotle, each human person can be likened to Hector, the tamer of horses – that is, each person faces the challenge of taming the spirited horse in his or her psyche.Now, my favorite scholar the American Jesuit polymath Walter J. Ong (1912-2003; Ph.D. in English, Harvard University, 1955) does not happen to advert explicitly to Plato and Aristotle in his relevant discussion of male agonistic tendencies in his book Fighting for Life: Contest, Sexuality, and Consciousness (Cornell University Press, 1981), the published version of his 1979 Messenger Lectures at Cornell University – a theme Ong also explored at length earlier in his book The Presence of the Word: Some Prolegomena for Cultural and Religious History (Yale University Press, 1967, esp. pages 191-222 and 236-241), the expanded version of his 1964 Terry Lectures at Yale University.However, for Aristotle, the cardinal virtue of courage is a key part of the overall matrix of cardinal virtues that includes moderation, prudence, and justice (that is, personal justice, as distinct from, say, legal justice and social justice).Even though Ong stopped well short of formulating anything as complicated as Aristotle’s interactive view of the four cardinal virtues, Ong does explore the interactive non-cognitive agonistic structures with the cognitive conceptualizations that emerge in his 1982 plenary address “The Agonistic Base of Scientifically Abstract Thought: Issues in Fighting for Life: Contest, Sexuality, and Consciousness” that is reprinted in An Ong Reader: Challenges for Further Inquiry (Cresskill, NJ: Hampton Press, 2002, pages 479-495). End of digression.In any event, perhaps we can liken Trump’s hyperthymia personality to a spirited horse that still needs to be tamed by his inner Hector, tamer of horses. Good luck with that, eh?I suspect that Mick Mulvaney urged senior White House officials to read Ghaemi’s book primarily because of his discussion of hyperthymia personality as possibly applying to Trump. However, Ghaemi also discusses certain prominent political leaders that he claims are psychologically normal. In this discussion Ghaemi works with an elaborate contrast between what he styles as depressive realism, the byproduct of having experienced depression, versus unrealistic optimism, the byproduct of never having experienced depression. In my estimate, Trump characteristically expresses delusional (according to Ghaemi) optimism of mentally healthy people – this is a key feature of his salesman persona.Trump’s psychological combination of hyperthymia with the unrealistic optimism of psychologically normal people is not a combination that Ghaemi discusses at length. However, it strikes me that both FDR and JFK also manifested this psychological combination, even though Ghaemi credits both of them with depressive realism (which Trump clearly does not have). Thus, manifesting depressive realism does not necessarily rule out also manifesting the delusional (according to Ghaemi) optimism of typically mentally healthy people. Nor does hyperthymia.
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