Mood Swings

A psychiatrist surveys the mind and the wider world

A First Rate Madness

Why mental illness enhances crisis leadership

Many great leaders have been mentally ill, mainly with severe depression and sometimes with mania.  This is not an entirely controversial statement.  It is generally accepted by historians that Abraham Lincoln had severe depression, and so did Winston Churchill.  Both were suicidal at times.  Some other figures are less well-known but the documentary evidence is relatively strong: General William Sherman was removed from command because of concerns that he was insane.  He appeared, in retrospect, to have experienced a manic episode with paranoid delusions; he also had,throughout his life, episodes of severe depression, along with occasional suicidal thoughts.  Mahatma Gandhi and Martin Luther King both made suicide attempts in adolescence, and each had at least two severe depressive episodes in their lifetimes.  

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Other examples are not as extreme. The concepts of dysthymia (mild depression) and hyperthymia (chronic hypomanic symptoms) are reasonably well-validated scientifically as abnormal temperaments, genetically and biologically related to depression and mania, respectively.  Using the definitions of those conditions, some leaders appear to have had hyperthymic temperaments (such as Theodore and Franklin Roosevelt, and John Kennedy).

 

This is not to say that all leaders had mental illness. Most leaders did not; most leaders were mentally healthy. And that may be the problem.  Mental health may not be as good for leadership as people often assume.

 

This would be the case if mental illness confers certain psychological advantages that may be useful for leadership.  Mania, for instance, is well associated with creativity. Depression, in many psychological studies, is associated with enhance realism.  Both may increase resilience. I have reviewed the scientific evidence for the occurrence of these positive aspects of mental illness elsewhere. If this evidence is correct, it may explain why mental illness might enhance, and mental health hinder, crisis leadership.

 

These are the themes of A First Rate Madness, just published.  I plan to provide more detail on various aspects in future posts, including some reaction to comments that I receive from readers.

In response to initial reactions to my recent article in the Wall Street Journal, and other interactions, I'll begin by emphasizing four points:

1.  My examples are not chosen superficially. There is good documentary evidence for the symptoms that I describe.  Diagnosing leaders from the past is more valid than in the present because the documentary evidence often increases with time, and our feelings about distant leaders are usually more objective than is the case with living leaders. 

 

2.  I am not diagnosing everyone. In fact I am diagnosing most leaders as healthy.  Only a minority are ill, but they happen to be the best crisis leaders.

 

3.  I am distinguishing between crisis and non-crisis leadership. Those who are mentally healthy are fine leaders in non-crisis situations, but they fail during crises. Vice versa for great mentally ill leaders.

 

4.  The intuition against my thesis has its roots in stigma, I believe. This prejudice underlies the notion that a leader we dislike must be mentally ill, or that mental health inherently is better than mental illness for leadership.  These ideas are based on a stigmatizing attitude towards mental illness, the view that it is inherently and completely harmful.  Mental illness certainly can be harmful in many ways, but not inherently and completely.

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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