No excellent soul is exempt from a mixture of madness. —Aristotle
Newt Gingrich’s sinking, soaring, and now sinking presidential candidacy has revived talk of a wild card in politics: the oft-murmured but only rarely broached question of leaders’ mental health. During the 2000 and 2008 Republican primaries, some adversaries of the famously hot-tempered John McCain circulated rumors that he was dangerously unstable, perhaps afflicted with PTSD from his ordeal as a POW. Now similar questions have hovered around the brazen, defiant, mercurial, and immodest Gingrich: Is this man too crazy to be president? Gingrich even has a family history; he teared up at an Iowa campaign event recalling his mother’s depression and bipolar disorder.
Dr. Nassim Ghaemi has some very interesting things to say about Newt Gingrich’s mental health and leadership qualities (see below). But he might turn the question on its head: Is this man crazy enough to be president in a troubled time?
Ghaemi, a professor of psychiatry at Tufts University School of Medicine and the director of the Tufts Medical Center’s Mood Disorders Program, made a stir last summer with his provocative book A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness. It challenged the assumption that healthy minds make good leaders, positing instead an inverse law of sanity: “The best crisis leaders are either mentally ill or mentally abnormal; the worst crisis leaders are mentally healthy.” Abraham Lincoln, Winston Churchill, John F. Kennedy, Adolf Hitler, Franklin Roosevelt, Mahatma Gandhi, Martin Luther King, Jr. — all suffered from depression and/or mania. By contrast, mentally balanced leaders such as Neville Chamberlain, Tony Blair, and (no kidding) Richard Nixon might fare well in times of peace and prosperity, but their normalcy is a liability in tough times, when realism and divergent thinking are critical.
The 2012 presidential election approaches at a time that cries out for bold, innovative crisis leadership, yet it appears the race will come down to the conspicuously even-keeled President Barack Obama and a dull, gray, Republican, perhaps the consummate manager Mitt Romney or the stolid ideologue Rick Santorum. It’s all fair game for Ghaemi, who also holds degrees in history, philosophy, and public health. We spoke extensively in November, and he interrupted his New Year’s Eve to comment further on the presidential contenders.
Nassir Ghaemi: Basically I’ve been treating and doing research on bipolar disorder and depression for almost two decades, and I knew from my own clinical experience and from my experience with other experts in the field that many of our patients were highly successful people: business people, politicians, professors, doctors, lawyers. But because of confidentiality issues and stigma, we often don’t know about these people. We think of mental illnesses like manic depression and depression as only harmful because we don’t hear about those who have them who are doing well.
I decided to bring out this link between depression and mania and success through public figures from the past because their information would be publicly available.
Lindley: In your introduction, you compare your work as a psychiatrist with that of a historian. How is it possible to make a diagnosis of a historical person when you don’t have a direct examination?
Ghaemi: Direct examination is overrated. The most important aspect of psychiatric diagnosis is the history, and it’s almost completely dependent on the history of the patient, [but] the history of the patient is poorly obtained if it’s solely from the patient. Many people do not realize what psychiatric symptoms they have. As clinical psychiatrists, what we must do is talk to family members, friends and other people to get outside information….
With historical figures, I would add that we have all these other sources of information and we can directly interact with the patient because we have their autobiographies, their memoirs and their letters.… I had primary sources and didn’t engage in psychoanalytic speculation.
Lindley: How can people with a mental illness be better leaders than people without mental illness?
Ghaemi: One important thing to do is show the association of the leaders and these conditions. The science is stronger in some aspects, and less strong in others, but it shows that four traits seem to stand out. One is realism, which is enhanced in depression, and this probably the most proven scientific positive trait. Many studies over 20 years show that people with a little depression are more realistically able to assess their surroundings and their environment and their control over their environment than people who are not depressed at all—people who are normal.
Empathy is a second trait enhanced by depression. There’s less research on this in terms of psychiatric work, but some research connects depression and empathy in psychiatric studies . Also neurobiological research I describe about how empathy is wired in the brain and has a biological aspect, which could be linked to biological conditions like depression.
The third trait is creativity, which I associate with mania. There’s a good deal of work connecting bipolar disorder prevalence with creative professions in the arts: writers, artists, musicians. In terms of divergent thinking, the idea that one’s thoughts go in many directions and this enhances creativity, or flight of ideas as psychiatrists call it, is one of the cardinal symptoms of mania. That’s better established than empathy, but there’s more work that needs to be done on mania and creativity.
The fourth trait, resilience, is probably better established than the others except maybe realism. There’s a lot of research on resilience and post-traumatic stress disorder and mania or manic symptoms. Hyperthymic temperament, which is mild manic symptoms as part of one’s personality, is protective against trauma and is a major factor for resilience.
Lindley: To go back to the history, it seems Lincoln, for example, manifested each of those enhanced traits in his leadership although he was morbidly depressed at times.
Ghaemi: Yes. I think Lincoln and Churchill are probably the most incontrovertible cases of severe depression among these leaders. General William Sherman is a prototype for both depression and mania.
All of them displayed probably all of these traits, although some to a lesser degree than others. For instance, I describe Lincoln as very realistic, which I relate to his depression. Obviously, he is known for being empathic toward black slaves, which might have been related to his depression as well. But the realism is underappreciated.
Lindley: Does realism get to Lincoln’s pessimism or optimism?
Ghaemi: He clearly wasn’t optimistic. That gets to another aspect. We tend to think it’s good to have optimistic leaders - “It’s morning in America,” as President Reagan said, and President Obama talking about hope. But Lincoln clearly was not optimistic.
Lindley: And you talk about hyperthymic personalities, especially with Franklin Roosevelt and John Kennedy. Do hyperthymia and dysthymia represent a set of personality traits rather than major psychiatric disorders?
Ghaemi: Right, and I think that’s a concept that’s difficult for people to understand. Everyone would like things to be black and white, but part of the message of A First-Rate Madness is that insanity is not all bad, insanity is not all good. There are gradations. You can have mild and moderate symptoms of depression and mania, which is a lot of what I’m describing the book, in which a person can be better functioning than a normal person.
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