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A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness [Hardcover]

Nassir Ghaemi
3.8 out of 5 stars  See all reviews (4 customer reviews)
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Book Description

4 Aug 2011

This New York Times bestseller is a myth-shattering exploration of the powerful connections between mental illness and leadership.

Historians 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 Programme at Tufts Medical Center, offers 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 lacklustre leadership of exceedingly sane men as Neville Chamberlain, A First-Rate Madness overturns many of our most cherished perceptions about greatness and the mind.

--This text refers to the Paperback edition.

Product details

  • Hardcover: 340 pages
  • Publisher: Penguin Putnam Inc (4 Aug 2011)
  • Language: English
  • ISBN-10: 1594202958
  • ISBN-13: 978-1594202957
  • Product Dimensions: 24.6 x 16.2 x 2.9 cm
  • Average Customer Review: 3.8 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Bestsellers Rank: 370,516 in Books (See Top 100 in Books)

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Ghaemi isn't the first to claim that madness is a close relative of genius, or even the first to extend the idea into politics. But he does go further than others...His explanations are elegant, too - intuitively accurate and banked off the latest psychiatric research. (Newsweek)

A First-Rate Madness is a sophisticated work of psychology, but it is also a gossipy work of celebrity history, a who's who of the eminently unhinged. (The New York Observer) --This text refers to the Paperback edition.

About the Author

Nassir Ghaemi, M.D., is a professor of psychiatry at Tufts University School of Medicine and director of the Mood Disorders Program at Tufts Medical Center in Boston. He has published more than a hundred scientific articles and several books on psychiatry. --This text refers to the Paperback edition.

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Customer Reviews

3.8 out of 5 stars
3.8 out of 5 stars
Most Helpful Customer Reviews
2 of 2 people found the following review helpful
Although this book may initially provide some interesting reading, I find it leads to, at least in one instance, some premature conclusions without complete and accurate information. As another reviewer in the United States once wrote, the author: "contrives the data to fit his thesis". I think at least on one of the personalities he wrote about I could honestly say his thinking was seriously flawed.

In Chapter Ten "A First Rate Temperament: Roosevelt" the author describes former American President Franklin Delano Roosevelt as someone whose hyperthymic personality "made him open to new ideas, and charismatic, but also, in the face of polio, hyperthymia helped him to be resilient, to rise above and better understand human suffering....His mind was agile and he did not recoil from the most terrible of decisions...He knew only people were hurting; he knew what it was like to hurt; and his personality would not allow him to sit still. He tried whatever worked and with that method achieved astounding success." The author writes that Roosevelt's polio "seems to have given him a degree of empathy that we've seen in other leaders who endured depression."

An agile mind? Not recoiling from terrible decisions? Increased empathy? I hardly think so and would STRONGLY disagree with that conclusion knowing what I know about the "rest of the story" as a Lithuanian-American whose parents fled their native country to escape certain death, imprisonment or forced deportation by Soviet occupation armies in 1944. Take Roosevelt's behavior at the Yalta conference in February 1945 as detailed in retired Lt Colonel Nargele's book
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5 of 6 people found the following review helpful
3.0 out of 5 stars Absolutely crazy 16 Nov 2011
By Hande Z
Ghaemi might be a first rate psychiatrist and teacher, but he ought to know that he cannot make a diagnosis of psychiatric conditions on any person unless he is the attending psychiatrist. None of the famous men he diagnosed were his patients. Consequently, he draws on facts from books and other records. In the case of Mahatma Gandhi's case, the author drew his facts mainly from Gandhi's autobiography, which the author (Ghaemi) suspected to have concealed facts. He then mad his diagnosis of Gandhi on the basis that the stories were true. Ghaemi also stated that a leader who is mani-depressive is not manic or depressed all the time, indeed, he is often "sane". If that were the case, how would Ghaemi know if the episodes or conduct of the personalities he discussed were performed during a lucid interval or in a moment of "madness"? In the end, some of his diagnoses may be correct, but without a proper medical and psychiatric examination, his diagnoses may also likely be flawed. The book's entire foundation was based on facts and history, which (as other reviewers have pointed out) have not been scrupulously checked, and is therefore suspect. The book was well written, but must be read with a dose of scepticism.
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4.0 out of 5 stars Great Read 18 Nov 2013
By Zachary
Format:Paperback|Verified Purchase
Simply intriguing, the authors inter-linking of multiple case studies is understandable, yet seems limited. Overall I would highly recommended !
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0 of 1 people found the following review helpful
5.0 out of 5 stars A must read for all Americans 19 July 2013
By McG
Format:Paperback|Verified Purchase
This is a fantastic book. I read it in almost one day (could not though). Author brilliantly examines, identifies and explains psychiatric conditions in some of USA's most beloved leaders. Helped me to understand behaviours that hitherto were somewhat opaque. Author is also using primary sources hitherto unutilized by other forensic historians. Top rating,
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Amazon.com: 3.8 out of 5 stars  124 reviews
174 of 191 people found the following review helpful
5.0 out of 5 stars Superb and insightful...essential reading. 8 Aug 2011
By David J. Spellman - Published on Amazon.com
Format:Hardcover|Verified Purchase
This is the best book I have read all year.
First of all, Dr. Ghaemi is a world-class psychiatrist; he is THE expert on issues of mood disorder (my wife is a psychiatrist and says that Dr. Ghaemi is the very best in the nation in his Continuing Medical Education teaching). So, he truly knows what he is writing about.
The structure of the book essentially follows the pattern of a chapter which describes the state-of-the-art in psychiatry as to a given diagnosis, followed by mini-biographies in two chapters of two historical figures who are exemplars of leadership with the particular diagnosis that Dr. Ghaemi has described. The manner in which he uses historical evidence to arrive at his diagnosis is seamless.
Among the historical figures profiled are Lincoln, General Sherman, Hitler, Gandhi, Churchill, Martin Luther King, Jr., FDR and JFK. There is a profile of Ted Turner, unusual because he is the only living example profiled (and the only non-political leader). Toward the end of the book there is extensive commentary about Nixon, Dubya, Tony Blair and some insights about Clinton, Truman, Eisenhower and even Newt Gingrich along the way.
I have read at least one biography of each figure he profiles (except for Ted Turner). I can vouch for the historical accuracy of Dr. Ghaemi's book in all regards except for two minor points about FDR: he was not a member of Woodrow Wilson's cabinet and he was not Secretary of the Navy (he was #2, the Assistant Secretary of the Navy).
The endnotes are also a magnificent treasure-trove of information.
Superb book, well-written by someone who knows his material.
I won't spoil your enjoyment with details about the profiles, but the essential thesis of the book is that we stigmatize mental illness but with the paradox that the very finest leaders in times of crisis or great challenge are mentally ill (sufficiently mentally ill to be great and effective leaders but not too much to have become incapacitated such as the monster Hitler).
Read. Enjoy. Benefit from this book.
73 of 96 people found the following review helpful
3.0 out of 5 stars Attention-getting, well worth reading, but not entirely convincing 17 Aug 2011
By M. S. Driver - Published on Amazon.com
Format:Hardcover|Verified Purchase
The title will certainly attract readers. This doctor's main thesis really should be at least considered as a pretty good explanation of the actions and behaviors (or lack of same) of some of our leaders, especially under duress. However, we probably should not find ourselves electing only "mentally ill" candidates just so that there will be highly creative and resilient people in the saddle in case a crisis occurs.

From the title alone, the reader may immediately infer that this book is all about the genius of schizophrenic presidents. That's not what the author wants to tell us. Dr. Ghaemi seems to have only one way to define "mental illness": "manic-depression" (or "bipolar disorder", as it's called today). He doesn't really come out at the start and state that it's only bipolar disorder that he will be discussing with regard to certain leaders. But schizophrenia and paranoia do not seem to fit into his analysis. He even states that neurosis is a normal part of the human personality, which came as a surprise to me.

I was ultimately satisfied by Dr. Ghaemi's arguments on the behaviors of the so-called "mentally ill" leaders he singles out as examples. The chapters on JFK and on Hitler and his Nazi entourage are real eye-openers.

But I was shocked by the doctor's arguments regarding Nixon, and by his dismissal of the extensive media and historical commentary, as well as the observations of millions of contemporary TV viewers, about this president's clearly visible mental state. He didn't sell me on this one.

As to the leaders whom Dr. Ghaemi does not select for his category of "mentally ill" -- among them Tony Blair, Truman and Eisenhower -- I agree with his assessment of the first man, but absolutely not the second or third. The doctor may know his psychiatry, but he certainly does not know his history! He makes the enormous gaffe of saying that, because WW II was "almost over when Truman took office", he didn't have to face a crisis. No, doctor, in April 1945 the war with Japan was nowhere near over, especially if it were to have been fought conventionally. The crisis facing Truman was as bad as any faced by the vaunted FDR in the entire course of the war. In case the good doctor needs to be informed of this fact: Truman, not his predecessor, was the one who had to make the courageous decision to drop two A-bombs in order to save the lives of thousands of American fighting men still in the Pacific, and he had the resilience to stand by that decision in the face of enormous criticism by his own country and its Allies. And Eisenhower, as a general, brilliantly executed D-Day, which was no less a crisis than the Japan decision later on (a point that the doctor overlooks entirely). Truman, Eisenhower and Sherman had all demonstrated resilience and creativity under pressure, but the doctor is saying that only Sherman was best suited to a crisis situation by being "ill" compared to either Ike or Truman, who were merely "healthy". Go figure.

This book necessarily uses jargon and word coinages that I had to keep thumbing back to, but the book is generally easily intelligible to a lay reader who is interested in psychology. It may be more trying for the casual reader. The author seems to be pitching to his colleagues as well as the general public. As to his theories, you probably could refute or defend them with equal vigor depending on what era you live in and how much biography and history you have read.
44 of 57 people found the following review helpful
5.0 out of 5 stars One Huge Point, Many Smaller Insights 29 Aug 2011
By Robert David STEELE Vivas - Published on Amazon.com
Format:Hardcover|Verified Purchase
When I am torn between a 4 and a 5 I read all the other reviews. I rate this book a five because it advances appreciation for the integration of psychology with history, and contributes somewhat--not the last word--to the rather vital discussion of why so many of our "leaders" are pedestrian, and what marks those who rise to extraordinary heights in the face of complex near catastrophic challenges.

Those critical of the book for the relatively brevity of the biographic sections, and the occasional mistakes, are in my view missing the huge point that really matters: in a time of extreme complexity and ambiguity, leaders with the most open of minds capable of very unconventional thinking are vital, and it just so happens that what what some call lunatic fringe or borderline personality have "the right stuff" for such times.

I have five pages of notes on this book. Below are some highlights and a few quotes.

The author refers to an inverse law of sanity and early on quotes Sherman as saying "In these times it is hard to say who are sane and who are insane." That is precisely how I feel as I watch Wall Street, Big Oil, the Military-Industrial Complex, and a two-party tyranny with a lame President pretending they have not already driven the Republic over the cliff.

The author's core argument is that in times of crisis, mentally ill leaders do better. While he exaggerates for effect, his essential argument is that "the establishment" produces sterile "well-adjusted" leaders who are best at following convention and staying within their "lanes in the road."

He cites four positive outcomes for leadership by the mentally-divergent as I prefer to label it:

+ Realism (the "normal" over-estimate stability, future prospects, and ease of staying normal)
+ Resilience (constant struggles with adversity harden the mentally-divergent more than those born to privilege)
+ Empathy (deep pain in self can arouse deep empathy for others including the unconscious who know not what they do)
+ Creativity (not just unconventional solutions, but finding problems others have not even noticed)

QUOTE (11): This theory argues that depressed people aren't depressed because they distort reality; they're depressed because t hey see reality more clearly than other people do.

QUOTE (13): A key aspect of mania is the liberation of one's thought processes...the emancipation of the intellect makes normal thinking seem pedestrian.

This is a good point to bring in Peter Drucker's quote, "Whenever anything is being accomplished, it is being done, I have learned, by a monomaniac with a mission."

QUOTE (15): The core of mania is impulsivity with heightened energy.

Abnormal personalities have three core traits in this book: neuroticism, extroversion, and openness to experience.

QUOTE (17): Citing German Psychiatrist Ernst Kretschmer, the first to connect insanity and genius, "Insanity is not a 'regrettable accident' but the 'indispensable catalyst' of genius."

I am reminded of Albert Einstein's definition of insanity: "Insanity is doing the same thing over and over again and expecting different results." That seems to sum up those who persist in doing the wrong things righter, throwing more money at everything from agriculture to water works without once stopping to do holistic analytics.

Although the biographies are shallow and focused on making the author's case, I find interesting nuggets in all of them, and consider the most negative reviews of this book to be missing the point. It offers a break-out idea and calls into question the competence of our leaders. For a long free online look at what I am thinking, look up "Integrity at Scale" by Stephen Howard Johnson.

Mania facilitates integrative complexity. Persistence matters--demands independence of character.

QUOTE (32): Sherman on Grant "He stood by me when I was crazy, and I stood by him when he was drunk."

Ted Turner's short bio is used to point out that CNN had integrity when he led it, and lost it when he left. This is also where the author observes that normal people severely over-estimate the degree of control and stability in their endeavors.

FDR on Churchill: He has a hundred ideas a day, four of which are good.

Churchill did not fit the times when both parties in England agreed that appeasement was the "bipartisan" course.

QUOTE (65): Churchill was relegated to the wilderness by Baldwin and others because his unconventional personna (partly reflecting his mood illness) provided an excuse to ignore his sadly realistic political judgment.

I am not a politician, but having been labeled "lunatic fringe" when I started the public Open Source Intelligence (OSINT) fight in 1992 with my article in Whole Earth Review, "E3i: Ethics, Ecology, Evolution, and Intelligence: An Alternative Paradigm for National Security," I can certainly see the insanity of my being on the sidelines while the Director of National Intelligence blows $80 billion a year on not much of anything worthwhile and fails to provide useful policy, acquisition, and operations decision-support for 96% of the Whole of Government.

Lincoln was a manic-depressive and deeply realistic and empathetic. Here I find my own mistake to chide the author on, he simply does not have the deep background needed. His representation of the Emancipation Proclamation is flat out wrong. Lincoln did NOT free the slaves in the North and South, and he only freed the slaves in the unoccupied south with reluctance and because of military necessity.

Both Gandhi and Martin Luther King attempted teen-age suicide. I learn that the black movement in the USA sought Gandhi out, and that he inspired them in their regard for non-violent resistance. I also learn that both Gandhi and Martin Luther King placed non-violent resistance above violent resistance, and (this is the part I did not know), violent resistance above passive acceptance.

Today in the USA 80% of the public is passively accepting a totally ignorant and corrupt federal government as well as the dominance of the 20% of the public that is flat-out ignorant, idiotic, and downright dangerous--the wing-nuts are on the march.

QUOTE (109): The real Martin Luther King was an "aggressive confrontational realist."

Resilience is spawned by mental illness.

FDR specifically appreciated the "lunatic fringe," observing that so many things that were "lunatic fringe" in his boyhood had become standard by the time of his presidency.

I learn that FDR refused to create a deficit burden on future Administrations despite the pressure to do so when he introduced Social Security. That is integrity. We lack that today in the federal government as well as state governments.

The chapter on John F. Kennedy for me is a stunning collage of the deep suffering over a young life that I had never understood.

The chapter on Hitler that upsets some people (the same people that missed Churchill's praise of Hitler's skill, energy, and focus) is fascinating.

QUOTE (207): Comparing the degeneration of Hitler in later years and the contrasting excellence of JFK, the author says "In leadership, and in life, drugs can make a major difference."

The entire section on Bush, Blair, Nixon, and others is boring for me, I know all this and have little regard for most of our so-called leaders, many of them fronts for the special interests that consider them nothing more than glorified pawns.

QUOTE (211): "Sanity...does not always, or even usually, produce good leadership."

Homoclites are "those who follow a common rule." I annotate: stay in their lanes and do not challenge convention.

The author's chapter on Nixon is interesting, but he does not realize that Nixon was the victim of a coup by the Bush Gang. While I mention this, I do not believe such limitations detract from the total value of the book.

QUOTE (233): A key characteristic of a homoclite leader is that he or she is effective and successful in peacetime or prosperity, but fails during war or crisis."

While I agree with that, I observe that the author does not provide for corruption and treason such as we have seen for too long at the highest levels of the US Government (political, political appointees, and compliant flag officers forgetting their Oath to support and defend the Constitution of the United States of America).

I am reminded of Bob Gates as well as Colin Powell and Brent Scowcroft and have the annotation: civility has replaced integrity as the core "value" for senior support staff.

The author makes it clear that Obama is a homoclite. I put the book down after a day's reflections on and off well-satisfied with the book in every respect including price. Our leaders today STINK. They are good people trapped in a bad system and not only do they not know how to retire rich while still serving the public interest, they look askance at those of us who do know the answer to the riddle of public service, of how to achieve public intelligence and public integrity in the public interest.

The author himself recommends:

The Psychology of Politics

I recommend, within my limit of nine remaining links:

Transforming Leadership
Leadership and the New Science: Discovering Order in a Chaotic World
Wave Rider: Leadership for High Performance in a Self-Organizing World
Radical Man
On the Psychology of Military Incompetence
Mapping the Moral Domain: A Contribution of Women's Thinking to Psychological Theory and Education
The Leadership of Civilization Building: Administrative and civilization theory, Symbolic Dialogue, and Citizen Skills for the 21st Century
Critical Choices. The United Nations, Networks, and the Future of Global Governance
No More Secrets: Open Source Information and the Reshaping of U.S. Intelligence (Praeger Security International)
25 of 32 people found the following review helpful
2.0 out of 5 stars Not a First-Rate Book 30 Aug 2011
By Esther K. Buddenhagen - Published on Amazon.com
Format:Kindle Edition|Verified Purchase
Dr Ghaemi's book goes awry right of the bat with its title which promises that we are going learn juicy stuff about madness and mental illness in our leaders. But unfortunately he plays fast and loose with terms. Madness suggests not just mental illness, but fairly extreme mental illness. Psychosis is madness. Catatonia is madness. True delusions are madness. False paranoia is madness. The persistent sadness of depression is a symptom of mental illness perhaps, but not madness. Perhaps someone who stays awake for days on end frantically churning out hundreds of paintings is mad. A bit of hypomania is not. Certainly there are leaders who have and have suffered from bona fide mental illnesses (and he discusses some of them). And some have been quite mad. But Ghaemi includes all the above under the umbrella of "madness." By being loosey-goosey with his definitions, by forcing his analyses into a power-point-like presentation, and because of his glibness and sloppiness with his evidence, he really doesn't get us anywhere very worth going. Which is a shame. We could certainly use more understanding of mental illness and just as much,we could use a better understanding of what to look for in selecting our leaders. We really would benefit from some insights into the not so obvious factors influencing how they make decisions: not only whom they owe and whom they might fear but how they want to be seen, what their core beliefs are, how they handle their anger, how they deceive themselves, how impulsive they are or how indecisive. We should want to know how well they can think creatively in addressing difficult relationships between various groups, in addressing conflicting interests, in presenting hard issues. How well can they work to persuade ordinary people, to care deeply about people?

Ghaemi sees the world through his lense of expertise in bipolar and depressive illnesses. Thus if someone doesn't fit his four categories for determining mental illness, he isn't mad. Thus, JFK is, but Hitler isn't. FDR is, but George W Bush isn't. But surely such complete hatred as Hitler seems to have felt for the Jews which is only one aspect of his truly strange behavior, must be a more true kind of madness than, say, Martin Luther King's depression. Indeed it's hard to imagine that Hitler's beliefs weren't truly delusional.

Very disturbing was Ghaemi's discussion of passive resistance and the movements of King and Gandhi. Ghaemi expresses the belief that anger not acted upon is anger repressed and thus harmful. I thought we'd moved beyond this belief about anger. Ghaemi attributes fighting amongst civil rights workers as evidence of repressed anger that had to come out. Groups fight amongst themselves fairly often whether pacifist or not. Ghraemi seems to advocate violence as necessary for mental health here. Obviously this is not the way humanity should solve its conflicts, though obviously we haven't learne much about how to move behyond it. Yet humanity's efforts to find alternatives are better than feeling one must express one's anger at the source of the anger. Surely more mental health experts advocate understanding one's feelings and then being able to step back and decide how to act effectively but not violently.

I also disagree with Ghaemi's characterization of personality tendencies. He sees the three dominant "mentally ill" types as hyperthymia, dysthymia and cyclothymia. Thus again, since Hitler doesn't in his view fit one of the three abnormal types, he is not mentally ill.

Sometimes Ghaemi refers to these personalities as simply abnormal, but makes clear they are not mentally "healthy." He presents as "normal" the person who is a homoclite -- the person who represents the largest percentage of humans in the US. His argument is that homoclites, or normal, regular people don't make good leaders in times of crisis. How on earth he could generalize from three or four examples of ANY of these "types" and think he was convincing beats me.He says the "abnormal" personalities have more empathy, for instance. I think many "normal" people who have had sick kids have a lot of empathy. The rainbow of human traits is many-hued. And one trait doesn't necessarily exclude another, especially in the case of "abnormal" vs. "normal" personalities. And as far as I know, a true lack of empathy is evident in antisocial personalities, who very likely are not depressed, manic or cycling, but certainly are not "normal."
13 of 16 people found the following review helpful
2.0 out of 5 stars If you care at all about historical accuracy, this book will annoy you. 12 Nov 2011
By Jamila G. Lewis - Published on Amazon.com
Format:Kindle Edition|Verified Purchase
I began reading this book in my free time at the beginning of the semester because it seemed interesting enough, and I wanted to learn something new. I have never studied psychology, but I have studied history, and thought it might be interesting to read about historical figures from a different perspective.

There are more than a few historical inaccuracies and ridiculous assumptions which Dr. Ghaemi presents as fact in order to affirm his thesis (ex: "Lincoln clearly empathized with slaves..."). I managed to overlook those until the chapter about FDR (Ch. 10), where because of my fascination with FDR, and Dr. Ghaemi's ridiculously blatant disregard for fact-checking, I had to stop reading.

The straw that broke the camel's back was the fact that twice (as far as I read), Dr. Ghaemi referred to "Hot Springs, Georgia". The town is called Warm Springs, and it is an actual town in Georgia where FDR owned a home, land, and where he died. This is a basic historical fact that one could confirm with a simple Google search, at yet, Dr. Ghaemi and his editors managed to overlook the existence of an entire town! That's like someone writing a book about the Civil War and deciding to refer to the burning of Hotlanta!

If you can't get simple historical facts straight, then you probably shouldn't be writing a book with any historical claim. Write fiction.
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