As a business psychologist who does a lot of leadership coaching and personality-based assessment work (and who in a former career was a mental health counselor), I was eager to read "A First Rate Madness". It's based on a counter-intuitive thesis: that in a time of crisis, mentally ill leaders are more likely to be effective than "normal" leaders. The author focuses on two main pathways to exceptional performance by mentally ill leaders: manic leaders who are able to be more creative and resilient than so called normal leaders, and depressed leaders who are capable of more empathy and realism than normal leaders.
The author cites many examples, such as Churchill (who suffered from bi-polar disorder) in the years leading up to World War II and his magnificent leadership during the 1940 Nazi invasion of the British Isles. The author's insights, based on rigorous research of original source documents (e.g., the medical records of Adolph Hitler), are compelling and shed new light on the actions of many world leaders such as JFK, Gandhi, Martin Luther King, Ted Turner, and Civil War "hero" General William Sherman. One example is his assertion that Hitler's actions did not become extremely dangerous until the late 1930s when he was receiving IV injections of amphetamines that turbo-charged his manic tendencies. The historical record supports this claim (more or less), though there is incontrovertible evidence that Hitler exhibited deranged thoughts with explosive potential many years earlier (e.g., in his 1923 manifesto Mein Kampf).
Judging the book from the standpoint of the author's main thesis (i.e., that mental illness can foster better leadership in a time of crisis), it is insightful and thought-provoking. Yet that same thesis created a huge blind spot for the author regarding the role of empathy in leadership. It's not that he doesn't address this topic. In fact, he devotes a whole chapter to it based on his core thesis: Depression -> Empathy -> Better Leadership in a Crisis. He goes on to say that "without empathy, we can barely communicate with each other". As we'll see below, this statement is untrue and reveals his blind spot: he fails to say a single word about the impact of leaders who LACK empathy. This blind spot is all the more startling given that a major personality disorder - psychopathy - is well known to psychiatrists (among them the author). Psychopaths are essentially con artists totally lacking in empathy who through charm, deceit, and intimidation often maneuver their way into powerful leadership positions where they can do great damage. They are able to feign empathy to get what they want, contrary to the author's statement that we can barely communicate without empathy. By way of contrast to this book, another recent one that also focuses heavily on the biological underpinnings of leadership behavior (Driven to Lead: Good, Bad, and Misguided Leadership by Paul Lawrence from the Harvard Business School) discusses at length these psychopathic "leaders without conscience".
My hunch is that the author's blind spot was caused by two factors: first of all, psychopathy (unlike depression or mania) can never be a force for good and has only negative consequences. Therefore, it falls outside the scope of the author's "mental illness can foster good leadership" thesis. Secondly, there is no known cure for psychopathy. It is immune even to the strongest drugs. Given that the use of drugs and other treatments is the foundation of modern day psychiatric practice, it's understandable why the author, as a practicing psychiatrist, would have nothing to say about a non-treatable disorder, even one that has enormous implications for leadership effectiveness. On balance, this is an excellent read for anyone interested in the topic, but approach it with a grain of salt and to get the most benefit, read it along with the "Driven to Lead" book mentioned earlier in this review.