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A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.

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

by Nassir Ghaemi

New York Penguin Press, 2011

340 pages



The title of the book bends the quip about an iconic American leader, President Theodore Roosevelt, who was described as "having a second-rate mind, but a first-rate temperament." Teddy Roosevelt, even with his quirkiness, seemed to have the right presence of mind to lead the nation into the changing environment and uncertainties of the dawning twentieth century. The author, Dr. Ghaemi, offers a provocative premise--individuals who experience mental illness are better suited to lead organizations, societies, and nations more so than "normal" people. He presents a counter proposition that individuals who are mentally healthy can be successful leaders in times of stability and certainty but fail during times of crisis.

The author has substantial credentials as practicing psychiatrist and director of the Mood Disorders Program at Tufts Medical Center, teaching faculty member at Harvard Medical School, and writer of numerous articles and books on mental illness. His charter seems an attempt to validate the approach that combines psychiatry with history (so-called psychohistory). The "hook" of the book and his approach are the links to the examination of senior leadership and discerning the traits of successful leaders. In this very readable work, the author effectively integrated his academic experience--in history, philosophy, medicine, and psychiatry--with a pragmatic application in an effort to identify leadership potential.

As is common in most texts in the leadership domain, the author asserts there are four characteristics required for successful leadership during crisis: realism, creativity, empathy, and resilience. Realism recognizes the brutal facts and challenges of the environment. Creativity generates other perspectives, potential methods, and innovative solutions to address emerging problems. Empathy provides an understanding of those people being led, partners, and adversaries. Resilience allows facing and overcoming obstacles--personal, organizational, and societal. Dr. Ghaemi posits these leadership characteristics are more likely associated with individuals who experience mental illness and deemed to suffer from some form of "insanity." The insanity is not psychosis or multiple personality, but the more commonly recognized diagnoses of mania, depression, and bipolar disorder. While lesser known, the author offers that hyperthymic (high extroversion, sociability, and energy) personality disorder is also characteristic of successful crisis leaders.

The book's jacket is a composite of three American presidents--Abraham Lincoln, Franklin Roosevelt, and John F. Kennedy--which leads the reader to infer that they were all afflicted with some "madness." The success of these leaders and others (William Tecumseh Sherman, Winston Churchill, Mahatmas Ghandi, Martin Luther King, Jr., etc.) examined in the text presents evidence that the consequences of the mental disorders made positive contributions to their performance in key leadership positions. Dr. Ghaemi focuses on a number of historical figures: national leaders (presidents, prime ministers, and dictators), military generals, as well as social and business leaders to support his case.

The author obviously did not personally observe or treat the subjects in the book, but he did have access to extensive medical records and notes, personal letters and journals, and public records. With those materials, he presents a reasonable four-step framework to diagnose the mental illness of each subject.

To contrast the leadership performance of mentally normal leaders, he appropriates the term "homoclites" and offers matched pairs case analyses of individuals in similar eras but with different environmental requirements. For example, Sherman is contrasted with George McClellan; Churchill with Neville Chamberlain; and Kennedy with Richard Nixon and Ronald Reagan. He also offers up President George W. Bush and British Prime Minister Tony Blair as homoclites who were unsuccessful leaders in times of national crises.

While interesting and provocative, the author is unconvincing in proving his two major propositions--that we need the "insane" to lead in crisis and "normal" leaders fail during crises. While the case study method can provide examples to illustrate both premises, it does not address equivocality and equifinality for the outcomes of success and failure. The historical studies of George Washington, Charles de Gaulle, Eisenhower, Mao, Margaret Thatcher, Golda Meier, Nelson Mandela, Muammar Gaddafi, and Saddam Hussein could easily challenge the insane and normal leader premise. In addition, the author makes assertions about contemporary leaders while their histories have yet to be written. Failing to follow his own methodology regarding historical figures, Dr. Ghaemi declares "normal" psychological profiles and diagnoses without benefit of medical records that he used as the validation of a previous leader's mental health.

In spite of the book's shortfalls, readers will readily accept its call to remove the stigma of mental illness. Our life experiences demonstrate there is a great deal of variance in the normal distribution of mental health--probably a flat rather than steep bell curve. The author effectively argues that mental illness if properly diagnosed and treated (by medical professionals and medication) should not preclude individuals from being contributing members of society and among its leaders. By extension, those afflicted by cancer or other debilitating illnesses who survive (with the assistance of the medical profession, luck, and personal fortitude) are held in high esteem and the subject of many inspirational biographies.

Similarly, for the military, our wounded warriors demonstrate toughness and perseverance under formidable circumstance with afflictions not of their doing or choosing. Illness and injury--physical or mental--may serve as the crucible experience that develops character and builds confidence in the ability to meet and overcome obstacles. We have seen this with contemporary military leaders such as amputee Generals Fred Franks and Eric Shinseki from the Vietnam era to those in the post-9/11 era who acknowledge their post-traumatic stress disorder (PTSD) like serving Generals Carter Ham, David Blackledge, and Gary Patton. It would seem imprudent to exclude a proven leader, regardless of disability, from the opportunity to continue to serve others.

Reviewed by Charles Allen, COL (USA Retired), Professor of Leadership and Cultural Studies, US Army War College
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Author:Allen, Charles
Date:Jun 22, 2012
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