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179 of 197 people found the following review helpful
5.0 out of 5 stars Superb and insightful...essential reading.
This is the best book I have read all year.
First of all, Dr. Ghaemi is a world-class psychiatrist; he is THE expert on issues of mood disorder (my wife is a psychiatrist and says that Dr. Ghaemi is the very best in the nation in his Continuing Medical Education teaching). So, he truly knows what he is writing about.
The structure of the book essentially follows...
Published on August 8, 2011 by David J. Spellman

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76 of 100 people found the following review helpful
3.0 out of 5 stars Attention-getting, well worth reading, but not entirely convincing
The title will certainly attract readers. This doctor's main thesis really should be at least considered as a pretty good explanation of the actions and behaviors (or lack of same) of some of our leaders, especially under duress. However, we probably should not find ourselves electing only "mentally ill" candidates just so that there will be highly creative and...
Published on August 17, 2011 by M. S. Driver


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179 of 197 people found the following review helpful
5.0 out of 5 stars Superb and insightful...essential reading., August 8, 2011
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This is the best book I have read all year.
First of all, Dr. Ghaemi is a world-class psychiatrist; he is THE expert on issues of mood disorder (my wife is a psychiatrist and says that Dr. Ghaemi is the very best in the nation in his Continuing Medical Education teaching). So, he truly knows what he is writing about.
The structure of the book essentially follows the pattern of a chapter which describes the state-of-the-art in psychiatry as to a given diagnosis, followed by mini-biographies in two chapters of two historical figures who are exemplars of leadership with the particular diagnosis that Dr. Ghaemi has described. The manner in which he uses historical evidence to arrive at his diagnosis is seamless.
Among the historical figures profiled are Lincoln, General Sherman, Hitler, Gandhi, Churchill, Martin Luther King, Jr., FDR and JFK. There is a profile of Ted Turner, unusual because he is the only living example profiled (and the only non-political leader). Toward the end of the book there is extensive commentary about Nixon, Dubya, Tony Blair and some insights about Clinton, Truman, Eisenhower and even Newt Gingrich along the way.
I have read at least one biography of each figure he profiles (except for Ted Turner). I can vouch for the historical accuracy of Dr. Ghaemi's book in all regards except for two minor points about FDR: he was not a member of Woodrow Wilson's cabinet and he was not Secretary of the Navy (he was #2, the Assistant Secretary of the Navy).
The endnotes are also a magnificent treasure-trove of information.
Superb book, well-written by someone who knows his material.
I won't spoil your enjoyment with details about the profiles, but the essential thesis of the book is that we stigmatize mental illness but with the paradox that the very finest leaders in times of crisis or great challenge are mentally ill (sufficiently mentally ill to be great and effective leaders but not too much to have become incapacitated such as the monster Hitler).
Read. Enjoy. Benefit from this book.
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76 of 100 people found the following review helpful
3.0 out of 5 stars Attention-getting, well worth reading, but not entirely convincing, August 17, 2011
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M. S. Driver (Woodside, NY United States) - See all my reviews
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The title will certainly attract readers. This doctor's main thesis really should be at least considered as a pretty good explanation of the actions and behaviors (or lack of same) of some of our leaders, especially under duress. However, we probably should not find ourselves electing only "mentally ill" candidates just so that there will be highly creative and resilient people in the saddle in case a crisis occurs.

From the title alone, the reader may immediately infer that this book is all about the genius of schizophrenic presidents. That's not what the author wants to tell us. Dr. Ghaemi seems to have only one way to define "mental illness": "manic-depression" (or "bipolar disorder", as it's called today). He doesn't really come out at the start and state that it's only bipolar disorder that he will be discussing with regard to certain leaders. But schizophrenia and paranoia do not seem to fit into his analysis. He even states that neurosis is a normal part of the human personality, which came as a surprise to me.

I was ultimately satisfied by Dr. Ghaemi's arguments on the behaviors of the so-called "mentally ill" leaders he singles out as examples. The chapters on JFK and on Hitler and his Nazi entourage are real eye-openers.

But I was shocked by the doctor's arguments regarding Nixon, and by his dismissal of the extensive media and historical commentary, as well as the observations of millions of contemporary TV viewers, about this president's clearly visible mental state. He didn't sell me on this one.

As to the leaders whom Dr. Ghaemi does not select for his category of "mentally ill" -- among them Tony Blair, Truman and Eisenhower -- I agree with his assessment of the first man, but absolutely not the second or third. The doctor may know his psychiatry, but he certainly does not know his history! He makes the enormous gaffe of saying that, because WW II was "almost over when Truman took office", he didn't have to face a crisis. No, doctor, in April 1945 the war with Japan was nowhere near over, especially if it were to have been fought conventionally. The crisis facing Truman was as bad as any faced by the vaunted FDR in the entire course of the war. In case the good doctor needs to be informed of this fact: Truman, not his predecessor, was the one who had to make the courageous decision to drop two A-bombs in order to save the lives of thousands of American fighting men still in the Pacific, and he had the resilience to stand by that decision in the face of enormous criticism by his own country and its Allies. And Eisenhower, as a general, brilliantly executed D-Day, which was no less a crisis than the Japan decision later on (a point that the doctor overlooks entirely). Truman, Eisenhower and Sherman had all demonstrated resilience and creativity under pressure, but the doctor is saying that only Sherman was best suited to a crisis situation by being "ill" compared to either Ike or Truman, who were merely "healthy". Go figure.

This book necessarily uses jargon and word coinages that I had to keep thumbing back to, but the book is generally easily intelligible to a lay reader who is interested in psychology. It may be more trying for the casual reader. The author seems to be pitching to his colleagues as well as the general public. As to his theories, you probably could refute or defend them with equal vigor depending on what era you live in and how much biography and history you have read.
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49 of 64 people found the following review helpful
5.0 out of 5 stars One Huge Point, Many Smaller Insights, August 28, 2011
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When I am torn between a 4 and a 5 I read all the other reviews. I rate this book a five because it advances appreciation for the integration of psychology with history, and contributes somewhat--not the last word--to the rather vital discussion of why so many of our "leaders" are pedestrian, and what marks those who rise to extraordinary heights in the face of complex near catastrophic challenges.

Those critical of the book for the relatively brevity of the biographic sections, and the occasional mistakes, are in my view missing the huge point that really matters: in a time of extreme complexity and ambiguity, leaders with the most open of minds capable of very unconventional thinking are vital, and it just so happens that what what some call lunatic fringe or borderline personality have "the right stuff" for such times.

I have five pages of notes on this book. Below are some highlights and a few quotes.

The author refers to an inverse law of sanity and early on quotes Sherman as saying "In these times it is hard to say who are sane and who are insane." That is precisely how I feel as I watch Wall Street, Big Oil, the Military-Industrial Complex, and a two-party tyranny with a lame President pretending they have not already driven the Republic over the cliff.

The author's core argument is that in times of crisis, mentally ill leaders do better. While he exaggerates for effect, his essential argument is that "the establishment" produces sterile "well-adjusted" leaders who are best at following convention and staying within their "lanes in the road."

He cites four positive outcomes for leadership by the mentally-divergent as I prefer to label it:

+ Realism (the "normal" over-estimate stability, future prospects, and ease of staying normal)
+ Resilience (constant struggles with adversity harden the mentally-divergent more than those born to privilege)
+ Empathy (deep pain in self can arouse deep empathy for others including the unconscious who know not what they do)
+ Creativity (not just unconventional solutions, but finding problems others have not even noticed)

QUOTE (11): This theory argues that depressed people aren't depressed because they distort reality; they're depressed because t hey see reality more clearly than other people do.

QUOTE (13): A key aspect of mania is the liberation of one's thought processes...the emancipation of the intellect makes normal thinking seem pedestrian.

This is a good point to bring in Peter Drucker's quote, "Whenever anything is being accomplished, it is being done, I have learned, by a monomaniac with a mission."

QUOTE (15): The core of mania is impulsivity with heightened energy.

Abnormal personalities have three core traits in this book: neuroticism, extroversion, and openness to experience.

QUOTE (17): Citing German Psychiatrist Ernst Kretschmer, the first to connect insanity and genius, "Insanity is not a 'regrettable accident' but the 'indispensable catalyst' of genius."

I am reminded of Albert Einstein's definition of insanity: "Insanity is doing the same thing over and over again and expecting different results." That seems to sum up those who persist in doing the wrong things righter, throwing more money at everything from agriculture to water works without once stopping to do holistic analytics.

Although the biographies are shallow and focused on making the author's case, I find interesting nuggets in all of them, and consider the most negative reviews of this book to be missing the point. It offers a break-out idea and calls into question the competence of our leaders. For a long free online look at what I am thinking, look up "Integrity at Scale" by Stephen Howard Johnson.

Mania facilitates integrative complexity. Persistence matters--demands independence of character.

QUOTE (32): Sherman on Grant "He stood by me when I was crazy, and I stood by him when he was drunk."

Ted Turner's short bio is used to point out that CNN had integrity when he led it, and lost it when he left. This is also where the author observes that normal people severely over-estimate the degree of control and stability in their endeavors.

FDR on Churchill: He has a hundred ideas a day, four of which are good.

Churchill did not fit the times when both parties in England agreed that appeasement was the "bipartisan" course.

QUOTE (65): Churchill was relegated to the wilderness by Baldwin and others because his unconventional personna (partly reflecting his mood illness) provided an excuse to ignore his sadly realistic political judgment.

I am not a politician, but having been labeled "lunatic fringe" when I started the public Open Source Intelligence (OSINT) fight in 1992 with my article in Whole Earth Review, "E3i: Ethics, Ecology, Evolution, and Intelligence: An Alternative Paradigm for National Security," I can certainly see the insanity of my being on the sidelines while the Director of National Intelligence blows $80 billion a year on not much of anything worthwhile and fails to provide useful policy, acquisition, and operations decision-support for 96% of the Whole of Government.

Lincoln was a manic-depressive and deeply realistic and empathetic. Here I find my own mistake to chide the author on, he simply does not have the deep background needed. His representation of the Emancipation Proclamation is flat out wrong. Lincoln did NOT free the slaves in the North and South, and he only freed the slaves in the unoccupied south with reluctance and because of military necessity.

Both Gandhi and Martin Luther King attempted teen-age suicide. I learn that the black movement in the USA sought Gandhi out, and that he inspired them in their regard for non-violent resistance. I also learn that both Gandhi and Martin Luther King placed non-violent resistance above violent resistance, and (this is the part I did not know), violent resistance above passive acceptance.

Today in the USA 80% of the public is passively accepting a totally ignorant and corrupt federal government as well as the dominance of the 20% of the public that is flat-out ignorant, idiotic, and downright dangerous--the wing-nuts are on the march.

QUOTE (109): The real Martin Luther King was an "aggressive confrontational realist."

Resilience is spawned by mental illness.

FDR specifically appreciated the "lunatic fringe," observing that so many things that were "lunatic fringe" in his boyhood had become standard by the time of his presidency.

I learn that FDR refused to create a deficit burden on future Administrations despite the pressure to do so when he introduced Social Security. That is integrity. We lack that today in the federal government as well as state governments.

The chapter on John F. Kennedy for me is a stunning collage of the deep suffering over a young life that I had never understood.

The chapter on Hitler that upsets some people (the same people that missed Churchill's praise of Hitler's skill, energy, and focus) is fascinating.

QUOTE (207): Comparing the degeneration of Hitler in later years and the contrasting excellence of JFK, the author says "In leadership, and in life, drugs can make a major difference."

The entire section on Bush, Blair, Nixon, and others is boring for me, I know all this and have little regard for most of our so-called leaders, many of them fronts for the special interests that consider them nothing more than glorified pawns.

QUOTE (211): "Sanity...does not always, or even usually, produce good leadership."

Homoclites are "those who follow a common rule." I annotate: stay in their lanes and do not challenge convention.

The author's chapter on Nixon is interesting, but he does not realize that Nixon was the victim of a coup by the Bush Gang. While I mention this, I do not believe such limitations detract from the total value of the book.

QUOTE (233): A key characteristic of a homoclite leader is that he or she is effective and successful in peacetime or prosperity, but fails during war or crisis."

While I agree with that, I observe that the author does not provide for corruption and treason such as we have seen for too long at the highest levels of the US Government (political, political appointees, and compliant flag officers forgetting their Oath to support and defend the Constitution of the United States of America).

I am reminded of Bob Gates as well as Colin Powell and Brent Scowcroft and have the annotation: civility has replaced integrity as the core "value" for senior support staff.

The author makes it clear that Obama is a homoclite. I put the book down after a day's reflections on and off well-satisfied with the book in every respect including price. Our leaders today STINK. They are good people trapped in a bad system and not only do they not know how to retire rich while still serving the public interest, they look askance at those of us who do know the answer to the riddle of public service, of how to achieve public intelligence and public integrity in the public interest.

The author himself recommends:

The Psychology of Politics

I recommend, within my limit of nine remaining links:

Transforming Leadership
Leadership and the New Science: Discovering Order in a Chaotic World
Wave Rider: Leadership for High Performance in a Self-Organizing World
Radical Man
On the Psychology of Military Incompetence
Mapping the Moral Domain: A Contribution of Women's Thinking to Psychological Theory and Education
The Leadership of Civilization Building: Administrative and civilization theory, Symbolic Dialogue, and Citizen Skills for the 21st Century
Critical Choices. The United Nations, Networks, and the Future of Global Governance
No More Secrets: Open Source Information and the Reshaping of U.S. Intelligence (Praeger Security International)
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8 of 9 people found the following review helpful
2.0 out of 5 stars Fascinating premise-flawed interpretation, August 22, 2012
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This review is from: A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness (Paperback)
First, let me say that Dr. Ghaemi deserves high praise for his premise, which is highly creative and deserving of respectful consideration. The effort he put into securing and analyzing the mental health records of the the leaders whom he studies is impressive. Next, let me say that Dr. Ghaemi carefully sought to be even-handed and even fair in his review of political figures. In ne instance, he comments on some admirable actions of Richard Nixon, which,in my experience, is unheard of. The book is worth reading.

However, my score reflects my belief that the connection between leadership and mental illness is unproven by Dr. Ghaemi's own examples. He uses Sherman's march through the South in the Civil War as an example of General Sherman's superior leadership caused by his mental illness. One may argue that the success attributed to Sherman might be better attributed to a better armed and trained army with the winds of victory at its back led by superior, and not so mentally ill, subordinate officers.

In my opinion, Abraham Lincoln stands as the equal of George Washington of the history of American presidents. Lincoln, by many accounts, struggled with depression and difficult personal relationships many times in his life. Did this increase his capacity for empathy and resilience? Possibly. Did this empathy with others affect his approach to the war? I am doubtful. In the dark days of the war, did resilience that he may have developed in the dark days of his personal life support him mentally? Perhaps.

As a approach to fighting the war, Lincoln's sought a general who "would fight," which General McClellan essentially failed to do and for which Lincoln fired him. But what Lincoln meant by "fight" was a general who would take casualties. Lincoln realized that the North had about twice as many men of military age as the South had. Thus, the North could trade casualties one for one with the South and still have men to fight when the South no longer did. When President Lincoln found General Grant he found a general who take "would fight" and take large casualties. The willingness to take casualties ultimately vindicated Lincoln. I am skeptical that it displayed empathy. It was the soldiers who were willing to fight and die led by aggressive Northern officers, whose contributions should not be overlooked.

Dr. Ghaemi ascribes empathy as well to President Franklin Roosevelt arising from depression with roots in adult-onset polio. Dr. Ghaemi makes a careful case for the effect of this illness on his mental state, which undoubtedly must have deeply affected President Roosevelt. However, while Roosevelt's efforts to bolster the nation during the Great Depression are unquestioned, most economic historians which I have studied fix the commencement of World War II as the event that pulled the nation from the grip of the Depression. I know of no historian who has expressed the opinion that President Roosevelt had anything to do with the initiation of WWII. So, any empathy might have temporarily boosted morale, but did not produce the employment levels that Americans desired.

Also, during WWII I believe that most historians would place many highly capable leaders at the President's side. Once again, historical events created the opportunity for great success, which is not to diminish President Roosevelt's leadership during WWII until his death. He unquestionably was liked by many who came into his presence, but I do not think that the case has been made that his native personal charisma was enhanced by any personal demons.

As a contrast, let me consider Dwight Eisenhower, who is mentioned n the book, but not analyzed. Eisenhower was probably a homoclite (think of this as a psychiatrist's technical term for a normal guy whatever that means). Therefore, Eisenhower probably was not tested, and perhaps tortured, by mental illness. However, Eisenhower is generally regarded as an exemplary leader. Perhaps he might be considered a little bland because he didn't have obvious mental issues, but a great leader nonetheless. I will focus on General Eisenhower's leadership leading up to the invasion of Europe in 1944. By all accounts, the planning and decisions leading up to June 6 were deeply stressful and mentally taxing. Yet Eisenhower performed admirably. Once again, the Allied forces that invaded were well trained, well armed, and well supplied. Perhaps more importantly, they, too, felt that they had wind of victory at their back. Many of Eisenhower's subordinate commanders were highly capable and in some cases more charismatic. For Eisenhower as for others, greatness came from performing at a high level on a very large stage.

As I consider the matter, I believe that much of my criticism flows from the limits of the "great man" theory of history. Great men, with or without mental illness, may have greatness ascribed to them because of the acts of highly capable subordinates and large masses of motivated homoclites, who in many instances are called to suffer.
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28 of 37 people found the following review helpful
2.0 out of 5 stars Not a First-Rate Book, August 30, 2011
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Esther K. Buddenhagen (Xico, Veracruz, Mexico) - See all my reviews
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Dr Ghaemi's book goes awry right of the bat with its title which promises that we are going learn juicy stuff about madness and mental illness in our leaders. But unfortunately he plays fast and loose with terms. Madness suggests not just mental illness, but fairly extreme mental illness. Psychosis is madness. Catatonia is madness. True delusions are madness. False paranoia is madness. The persistent sadness of depression is a symptom of mental illness perhaps, but not madness. Perhaps someone who stays awake for days on end frantically churning out hundreds of paintings is mad. A bit of hypomania is not. Certainly there are leaders who have and have suffered from bona fide mental illnesses (and he discusses some of them). And some have been quite mad. But Ghaemi includes all the above under the umbrella of "madness." By being loosey-goosey with his definitions, by forcing his analyses into a power-point-like presentation, and because of his glibness and sloppiness with his evidence, he really doesn't get us anywhere very worth going. Which is a shame. We could certainly use more understanding of mental illness and just as much,we could use a better understanding of what to look for in selecting our leaders. We really would benefit from some insights into the not so obvious factors influencing how they make decisions: not only whom they owe and whom they might fear but how they want to be seen, what their core beliefs are, how they handle their anger, how they deceive themselves, how impulsive they are or how indecisive. We should want to know how well they can think creatively in addressing difficult relationships between various groups, in addressing conflicting interests, in presenting hard issues. How well can they work to persuade ordinary people, to care deeply about people?

Ghaemi sees the world through his lense of expertise in bipolar and depressive illnesses. Thus if someone doesn't fit his four categories for determining mental illness, he isn't mad. Thus, JFK is, but Hitler isn't. FDR is, but George W Bush isn't. But surely such complete hatred as Hitler seems to have felt for the Jews which is only one aspect of his truly strange behavior, must be a more true kind of madness than, say, Martin Luther King's depression. Indeed it's hard to imagine that Hitler's beliefs weren't truly delusional.

Very disturbing was Ghaemi's discussion of passive resistance and the movements of King and Gandhi. Ghaemi expresses the belief that anger not acted upon is anger repressed and thus harmful. I thought we'd moved beyond this belief about anger. Ghaemi attributes fighting amongst civil rights workers as evidence of repressed anger that had to come out. Groups fight amongst themselves fairly often whether pacifist or not. Ghraemi seems to advocate violence as necessary for mental health here. Obviously this is not the way humanity should solve its conflicts, though obviously we haven't learne much about how to move behyond it. Yet humanity's efforts to find alternatives are better than feeling one must express one's anger at the source of the anger. Surely more mental health experts advocate understanding one's feelings and then being able to step back and decide how to act effectively but not violently.

I also disagree with Ghaemi's characterization of personality tendencies. He sees the three dominant "mentally ill" types as hyperthymia, dysthymia and cyclothymia. Thus again, since Hitler doesn't in his view fit one of the three abnormal types, he is not mentally ill.

Sometimes Ghaemi refers to these personalities as simply abnormal, but makes clear they are not mentally "healthy." He presents as "normal" the person who is a homoclite -- the person who represents the largest percentage of humans in the US. His argument is that homoclites, or normal, regular people don't make good leaders in times of crisis. How on earth he could generalize from three or four examples of ANY of these "types" and think he was convincing beats me.He says the "abnormal" personalities have more empathy, for instance. I think many "normal" people who have had sick kids have a lot of empathy. The rainbow of human traits is many-hued. And one trait doesn't necessarily exclude another, especially in the case of "abnormal" vs. "normal" personalities. And as far as I know, a true lack of empathy is evident in antisocial personalities, who very likely are not depressed, manic or cycling, but certainly are not "normal."
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4 of 4 people found the following review helpful
4.0 out of 5 stars "But what about Hitler?", September 4, 2012
This review is from: A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness (Paperback)
This is the question that every student in my leadership course always asks. A four-word question that has received an avalanche of talk and text in reply, yet we still don't have a satisfactory understanding to the deep conundrum behind this complex question. How, my students are asking, could someone, albeit someone considered evil, with the talent to inspire and mobilize millions of people -- to lead a demoralized and bankrupt nation to the brink of conquering the world -- not be considered an effective leader?

Most leadership texts contend that any leader who does not lead for the good of the people can't be considered effective. Some scholars categorize these leaders as "negative charismatics." They are talented, but apply their talents to ends that are at least selfish and at worst evil. And with that, those of us who study leadership are able to dismiss not only Hitler, but others of his ilk: Mao, Stalin, Jim Jones, etc.

Nevertheless, the deeper conundrum remains. How to explain not only these negative charismatics, but leaders of great talent who behave recklessly, take big risks and sometimes succeed beyond all measure? And at other times, bring their successful careers crashing down, end up in jail, or in the case of presidents, compromise their legacies and undermine their places in history? Think of Bill Clinton and JFK with their sex-capades. Or of FDR, who carried on a long-term affair with Lucy Mercer, secretary to his wife Eleanor, and quite possibly with his own secretary, Missy LeHand, as well. Why would leaders of this caliber, supposedly mature men, risk their standing in this way?

Author Nassir Ghaemi thinks he has the answer to this and related questions, and he details his reasoning in his most fascinating book, A First Rate Madness: Uncovering the Links Between Leadership and Mental Illness. Not only does Ghaemi attempt to explain the behaviors of high-energy risk takers, he also examines great leaders on the other end of the spectrum, such as Churchill and Lincoln, both of whom evidenced depressive disorders. Ghaemi posits that mild mental illness actually assists those who lead in crisis situations and that the "normal" leaders often chosen by the electorate, a group he terms "homoclites," perform sub-optimally in crisis situations precisely because they are "average."

"Crisis" is the operative word here. In non-crisis times, Ghaemi says, a homoclite leader is fine. S/he rocks along, doesn't mess things up and the world continues to turn as usual. The trouble arises when a homoclite is in charge during a crisis. Ghaemi makes an intriguing case and also raises a host of related, equally provocative questions. I am not entirely sure that I buy all of his arguments and, as other reviewers have pointed out, there is much room for political biases to intrude in a psychoanalysis. Nevertheless, A First-Rate Madness is a provocative read and worthy of consideration if you are a person who is interested in the relationship between personality (some might say character) and leadership effectiveness.
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17 of 22 people found the following review helpful
4.0 out of 5 stars A Fascinating but Flawed Exploration of the Link Between Mental Illness and Leadership, August 27, 2011
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As a business psychologist who does a lot of leadership coaching and personality-based assessment work (and who in a former career was a mental health counselor), I was eager to read "A First Rate Madness". It's based on a counter-intuitive thesis: that in a time of crisis, mentally ill leaders are more likely to be effective than "normal" leaders. The author focuses on two main pathways to exceptional performance by mentally ill leaders: manic leaders who are able to be more creative and resilient than so called normal leaders, and depressed leaders who are capable of more empathy and realism than normal leaders.

The author cites many examples, such as Churchill (who suffered from bi-polar disorder) in the years leading up to World War II and his magnificent leadership during the 1940 Nazi invasion of the British Isles. The author's insights, based on rigorous research of original source documents (e.g., the medical records of Adolph Hitler), are compelling and shed new light on the actions of many world leaders such as JFK, Gandhi, Martin Luther King, Ted Turner, and Civil War "hero" General William Sherman. One example is his assertion that Hitler's actions did not become extremely dangerous until the late 1930s when he was receiving IV injections of amphetamines that turbo-charged his manic tendencies. The historical record supports this claim (more or less), though there is incontrovertible evidence that Hitler exhibited deranged thoughts with explosive potential many years earlier (e.g., in his 1923 manifesto Mein Kampf).

Judging the book from the standpoint of the author's main thesis (i.e., that mental illness can foster better leadership in a time of crisis), it is insightful and thought-provoking. Yet that same thesis created a huge blind spot for the author regarding the role of empathy in leadership. It's not that he doesn't address this topic. In fact, he devotes a whole chapter to it based on his core thesis: Depression -> Empathy -> Better Leadership in a Crisis. He goes on to say that "without empathy, we can barely communicate with each other". As we'll see below, this statement is untrue and reveals his blind spot: he fails to say a single word about the impact of leaders who LACK empathy. This blind spot is all the more startling given that a major personality disorder - psychopathy - is well known to psychiatrists (among them the author). Psychopaths are essentially con artists totally lacking in empathy who through charm, deceit, and intimidation often maneuver their way into powerful leadership positions where they can do great damage. They are able to feign empathy to get what they want, contrary to the author's statement that we can barely communicate without empathy. By way of contrast to this book, another recent one that also focuses heavily on the biological underpinnings of leadership behavior (Driven to Lead: Good, Bad, and Misguided Leadership by Paul Lawrence from the Harvard Business School) discusses at length these psychopathic "leaders without conscience".

My hunch is that the author's blind spot was caused by two factors: first of all, psychopathy (unlike depression or mania) can never be a force for good and has only negative consequences. Therefore, it falls outside the scope of the author's "mental illness can foster good leadership" thesis. Secondly, there is no known cure for psychopathy. It is immune even to the strongest drugs. Given that the use of drugs and other treatments is the foundation of modern day psychiatric practice, it's understandable why the author, as a practicing psychiatrist, would have nothing to say about a non-treatable disorder, even one that has enormous implications for leadership effectiveness. On balance, this is an excellent read for anyone interested in the topic, but approach it with a grain of salt and to get the most benefit, read it along with the "Driven to Lead" book mentioned earlier in this review.
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12 of 15 people found the following review helpful
2.0 out of 5 stars interesting, but selectively referenced., September 19, 2011
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The author presents an interesting thesis: great crisis leaders and "mental illness" in the form of various degrees of depression, mania or both are linked. Unfortunately, he has selectively chosen a limited number of leaders with problems to justify his point and ignored "normal" leaders who could also be considered great, for example Harry Truman. The author makes no reference to earlier works by physicians who are considered experts in this field, especially Jerrold Post or the British author Hugh L'Etang.
I read this book hoping to gain some new insights into leadership, especially at the national level. Unfortunately, I think it told me more about the author and his selective biases.
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28 of 38 people found the following review helpful
1.0 out of 5 stars Hard to imagine anyone could write anything this bad..., March 3, 2012
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First, I agree with all of the comments in the one star reviews...I also agree with most of what Janet Maslin says in her NYT review...I'm a bit more harsh, however, since I think this thing should be listed as fiction...the author's basic thesis is "The best crisis leaders are either mentally ill or mentally abnormal; the worst crisis leaders are mentally healthy."...then he proceeds to pick "great' leaders -- i.e. leaders that he thinks help support his thsis -- and then picks out isolated incidents -- the ones that support his thesis -- and the "abnormal behavior" -- as he defines it -- displayed...he then constructs a diagnosis accordingly...there is so much "goofiness' in consequence that it's difficult to know where to start criticizing much less to know which words will communicate adequately the depth of that "goofiness"...

I was particularly annoyed at his treatment of William Tecumseh Sherman wherein the author manages to diagnose -- from isolated incidents -- a bipolar disorder. For what it is worth, I will absolutely deny -- having read everything that Sherman himself ever wrote as well as more books about Sherman and the events that occurred during his lifetime than anyone could probably imagine -- that Sherman had any elements of bipolar disorder or any of its subtypes as characterized by DSM-IV-TR. Any psychiatric diagnosis requires examination of an individual's entire life. You can't simply pick and chose events -- particularly stressful events -- to support your diagnosis. Indeed, how someone manages their life during their "normal" times is probably just as important. You also have to consider context. A marine drill sergeant might be considered obsessive-compulsive but within the context of the occupation, their behavior is considered reasonable. You also have to be highly skeptical of secondary and anecdotal sources. Journalists, for example, may be prone to exaggerate a description for the purpose of enlivening an article. Sherman, throughout his life, demonstrated level headed, normal behavior consistent with someone who was West Point educated and who had endured the hardships of war and frontier life. If anything, what is truly remarkable is how little "odd" behavior Sherman exhibited given the conditions he faced and the scrutiny to which he was subjected.

Ghaemi also makes a mess of his analysis of Lincoln. I lack time to rebut his attempt at diagnosing Lincoln with depression. However, I will point out that he simply ignores that Lincoln, despite the death of two sons and despite having to live with a woman who probably was TRULY mentally ill, nevertheless managed to get up and daily deal with the divergent and difficult personalities of his cabinet members as well as with the other hectic aspects of a presidential life. NOT ONLY THAT, despite multiple setbacks and disappointments, he managed the fighting of a civil war AND his re-election to boot! Yet this "psychiatrist" thinks Lincoln suffered clinical depression? Has this psychiatrist ever actually managed a patient with clinical depression? I am confident that a survey of psychiatrists would NOT support the notion that ANYBODY with true depressive illness could cope with the situations Lincoln faced. Even with modern drugs it would be challenging if not impossible.

Indeed, throughout the book, the author seems to confuse "situational" depression with true clinical depression and bipolar disorder. Everyone typically manifests "abnormal" behavior in times of stress -- e.g. loss of employment, death of family member. Such depression and its accompanying behavior usually is transient and resolves as the individual adapts to the situation. But that is not true clinical depression where the symptoms are unrelenting and accompanied by suicidal thoughts and other diagnostic characteristics. By the same token, "mania" is not simply "nervousness" or "hyperactivity." It's a complex of pressured speech, racing thoughts, delusions, and other symptoms that typically render the individual incapable of productive functioning. Someone in the grips of a true "manic" episode would be hardly capable of writing their name much less of managing a complex leadership position.

So, no, I'm afraid I can't recommend anyone waste any time reading this book.
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14 of 18 people found the following review helpful
1.0 out of 5 stars Correlation Is Not Causation, November 22, 2011
While it may be true that some fine "crisis" leaders had mental illnesses (and some of the author's arguments for such are specious) it suggests poor reasoning to state that these illnesses are RESPONSIBLE for their good leadership. And to say that poor crisis leaders are bad because they are NOT mentally ill is, well, simply idiotic. One gets the feeling that the author is of the 'Procrustean Bed" school of authorship. For instance, he dismisses narcissism as a scientifically unfounded diagnosis because that would make George W. Bush mentally ill, thus messing up his theory. If these criticisms were not indictment enough, the book is really not about "uncovering the links between leadership and mental illness" as stated in the subtitle, but a regurgitation of the author's premise as seen through the lens of Reader's Digest versions of biographies of famous leaders. I suggest you read something else.
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A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness
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