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

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.

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.

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.