In A First Rate Madness, I diagnosed depression or bipolar disorder - or their temperaments - in historical leaders. One question raised, especially by some major media reviews, was how one can legitimately make such diagnoses historically. How can one document such diagnoses?
This legitimate question was sometimes tied to the observation of minor historical errors, thereby throwing into doubt the historical research of the book. The text probably contains over 1000 historical and psychiatric facts; if there were even a dozen minor errors of historical fact, this would reflect a >99% accuracy rate. I appreciate that such minor errors need to be corrected, but they do not relate to the major pieces of historical evidence that relate to the psychiatric diagnoses of depression or bipolar disorder.
In fact, in all cases where I make such diagnoses, I rely almost entirely on primary source material: direct observations of family or friends, contemporary newspaper accounts, personal letters, or medical records, including original scholarship for this book. For instance, I believe I am the first psychiatrist to analyze and document John F. Kennedy's medical records; those records are not allowed to be copied, and I hand wrote and then typed many important medical documents into the endnotes. These include the following: a) the verbatim transcript of Kennedy's medical discharge from the Navy in World War II, which shows that he was not discharged mainly for war injuries; b) the verbatim transcript of his back x-rays in the White House which show that he did not have major non-surgical bone disease to explain his pain; c) verbatim nursing notes from his first year in the White House documenting a serious Addisonian crisis, something not reported in most recent Kennedy biographies (a fact also documented in the endnote by reference to multiple highly cited biographies) d) documentation of the urine culture which proves a high-fatality sexually transmitted bacterium as the cause for the above infection; e) documentation of the frequency and amounts and types of steroid injections given throughout the White House years, and through most of the prior decade. None of this information is found, either in content or this level of detail, in most Kennedy biographies, including the one by Robert Dallek which, until now, had provided the most medical documentation on President Kennedy.