Book Review

Men who were good in a crisis - because of mental illness

Nassir Ghaemi examines Winston Churchill (pictured), Martin Luther King, and Franklin Roosevelt, among others. Nassir Ghaemi examines Winston Churchill (pictured), Martin Luther King, and Franklin Roosevelt, among others. (The New York Times)
By Alice Gregory
August 3, 2011

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By the time F. Scott Fitzgerald’s daughter left home for college, the famous writer was destroyed, destitute, and usually drunk. Still, he found it in himself to write her a letter before she embarked for school, one whose message was more solemn than celebratory.

He encouraged her “to form what, for lack of a better phrase, I might call the wise and tragic sense of life. . . . By this I mean the thing that lies behind all great careers, from Shakespeare’s to Abraham Lincoln’s.’’ He counseled her that “the redeeming things are not ‘happiness and pleasure’ but the deeper satisfactions that come out of struggle.’’ Fitzgerald’s depression and alcoholic self-medication are well-documented. But clearly he was not advising his daughter to pursue either disease. His letter was less prescriptive than it was self-descriptive.

The mutual constitution of success and suffering - and its more exaggerated analogue, genius and insanity - is a concept we’ve maintained for centuries. Usually we think of the relationship in terms of artistry - melancholy poets and brooding painters - but what if mental illness informs good leadership qualities, too? What if our contemporary political landscape has been shaped by madmen?

These are the questions that animate Nassir Ghaemi’s new book “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.’’ “Most of us make a basic and reasonable assumption about sanity.’’ writes Ghaemi, “We think it produces good results, and we believe insanity is a problem . . . [but] in at least one vitally important circumstance, insanity produces good results and sanity is a problem.’’ His thesis is fashionably counterintuitive, and also italicized: “The best crisis leaders are either mentally ill or mentally abnormal; the worst crisis leaders are mentally healthy.’’

The book is a glistening psychological history, faceted largely by the biographies of eight famous leaders, which Ghaemi uses to illustrate the characteristics he believes to be at once most crucial to successful sovereignty and also most exaggerated by mental illness. “A First-Rate Madness’’ is organized by these attributes, with each main section encompassing two lives, twinned in their specific symbiosis of efficacy and ailment. “Creativity’’ is epitomized by William Tecumseh Sherman and Ted Turner; “Realism’’ by Winston Churchill and Abraham Lincoln; “Empathy’’ by Mahatma Gandhi and Martin Luther King; and “Resilience’’ by Franklin Delano Roosevelt and John F. Kennedy.

A professor of psychiatry at Tufts University School of Medicine, Ghaemi takes a surprisingly nonclinical approach to his subjects’ biographies. His primary sources are selected as much for literary merit as for medical specificity. In his chapter devoted to Lincoln, he quotes an archival letter written by one of the former president’s close friends: “The Doctors say he is within an inch of being a perfect lunatic for life.’’

“A First-Rate Madness’’ is carefully plotted and sensibly argued. Ghaemi makes sure to provide frequent counterexamples of less-than-successful-leaders whose ambitions were actually thwarted by their sanity. For every Sherman - remembered as a military genius despite his mania and bloodthirst - there’s a George McClellan, the Civil War general who “evolved in the opposite direction - from precocious sensation to plain dud.’’ And though Ghaemi’s structuring principle might appear suspiciously symmetrical, one doesn’t get the sense that his book is one of Ivory Tower gamesmanship. Ghaemi believes that the eight men whose life stories he tells “suggest a relatively consistent pattern that, if true, has been largely ignored by historians and the public, but that may have in fact shaped the second half of the twentieth century more than any other single force.’’

In Ghaemi’s research is an implicit explanation of our nation’s current state of affairs. “[N]o serious politician has ever admitted to being depressed,’’ he writes. “Abraham Lincoln couldn’t become president these days, nor could Winston Churchill become prime minister. Of course Lincoln and Churchill hid their severe depressions from their respective electorates. But will we, as a society, ever evolve to the point where we can seek out our Lincolns and Churchills instead of getting them despite ourselves?’’ “A First-Rate Madness’’ is a collection of recursive readings, but Ghaemi’s ambition is more than mere retroactive pathologizing. It’s a political diagnosis.

Alice Gregory is a freelance writer whose work has appeared in New York, The Poetry Foundation,, and The New York Observer. She can be reached at


Uncovering the Links Between Leadership and Mental Illness

By Nassir Ghaemi

Penguin, 340 pp., 27.95