On Friday, Michael Wolff, the author of the new book Fire and Fury, said on The Today Show, “Let me put a marker in the sand here: 100% of the people around him” think that President Trump is mentally unfit to serve. Immediately, the floodgates opened. Journalists everywhere started opining about Donald Trump’s mental health.
When I heard Wolff speak, I thought of the work of Dr. Nassir Ghaemi. The author of A First Rate Madness: Uncovering the Links between Leadership and Mental Illness (2011; 2015 in paperback), Ghaemi argues two things about mental health and leadership. First, he says many of our best crisis leaders have had serious mental health illnesses that were beneficial to them. Second, given this information, we shouldn’t exclude people from public office because of their mental illness.
Personally, I firmly believe that we shouldn’t be opining on President Trump’s mental health because of the precedent it might set, not just for public office but for all professions. But I think the best thing to do is to read Dr. Ghaemi’s words. Below are the transcripts from his appearance on my radio show in August 2016 and on CNN this past Saturday.
August 25, 2016 on Sirius XM Radio
MS: I have just read a provocative new book, new insofar as it’s been released in paperback. It’s a New York Times bestseller by Dr. Nassir Ghaemi and it addresses this provocative question. Should the mentally ill be excluded from positions of political power? In his book A First-Rate Madness, he argues the following: the best crisis leaders are either mentally ill or mentally abnormal. The worst crisis leaders are mentally healthy. This is Dr. Ghaemi here to make his points. Doctor, thanks so much for your time.
NG: Thank you, glad to be with you.
MS: You delve deeply into a number of well-known personalities, some contemporary, some historical figures. Ted Turner makes that list. Let’s start with him. What’s known about Ted Turner from a mental health standpoint?
NG: Well, about 20 years ago in the early 90s, he was public about having been diagnosed with bipolar disorder and being treated with lithium and he stated at the time that it was helpful to him and, and he was married at the time to Jane Fonda and CNN was doing very well. And some years later, he went, publicly said that he didn’t think he had bipolar disorder anymore and he went off lithium and that’s when he got divorced and also sold CNN or merged CNN with Time Warner and then ended up losing the network. So there was a time when he was quite open about having bipolar illness and being treated for it.
MS: What does that mean? That diagnosis is something that as laypeople, I don’t know that we totally understand.
NG: Well it basically means having moods, episodes of either depression or mania. Mania is the opposite of depression. So depression we understand as being slowed down in your thinking, movements, and feelings and in severe cases one can even be suicidal. Mr. Turner’s father for instance was diagnosed with manic depressive illness, was psychiatrically hospitalized and committed suicide. It is a highly genetic condition. And the opposite of depression, the manic side is when you have rapid increased movements, feelings, and thoughts and so your energy level is up, you’re much more productive, you’re doing many things. On the extreme end, you can be impulsive and do things that can be harmful to you like spending a lot of money or getting into car accidents. So it’s basically your moods going up and down more severely than in the average person.
MS: So is your argument, do you go so far, I know the answer of course, but I’ll ask for the benefit of my radio audience. Do you go so far as to argue that Ted Turner was a success because of, rather than despite his bipolar symptoms?
NG: Exactly. I’m not saying it’s the only reason he’s a success, but I think it was a necessary ingredient in his personality, in his education and in his knowledge. All of the things that makes up to be a human being, one part of it is our psychology and when one has manic depressive illness as a genetic condition, it becomes part of who you are and that is actually a benefit, if you wanna be an entrepreneur because many symptoms make you…
MS: How so?
NG: Okay. Well the, so the, there are some positive aspects to having these conditions and along with the well-known negative ones and the research has shown that manic states are associated with increased creativity and increased resilience to trauma. That means that you’ll be doing more things that other people can’t think of and also when you run into problems, you survive it better and you come back from that. Depressive symptoms are associated with increased empathy towards others and increased realism. You’re able to be more aware of your circumstances in a more realistic way. And these traits are exactly what makes for a great crisis leader.
MS: I’m gonna ultimately ask you, but what about in a non-crisis time? Let’s not go there yet, let’s talk about a few other examples from your book. The man of the 20th century, Winston Churchill. First of all, why does he even factor into a book like A First-Rate Madness?
NG: Well, Churchill is one of the cases I think that’s very well established still. He was diagnosed and treated with psychiatric conditions while he was living. His physician wrote his, published his diaries about 10 years later after Churchill died, documenting all this. Churchill was diagnosed with severe depressive episodes, had them, he was treated with amphetamines for them which is, was the standard treatment in the 1930s and 40s. And he was also diagnosed with cyclothymia which is exactly this manic depressive mild mood swings that people can have all the time, they’re always a little up and down and that was one of the diagnoses his neurologist gave him. And I think that again Churchill showed a lot of realism in the 1930s when everyone else was more or less ignoring the Nazi threat and he was very depressed at the time. There were times he couldn’t even get up and go to Parliament. He expressed suicidal thoughts at times. At the same time, he was a very creative and resilient person obviously in terms of being the leader that stood up to the Nazi threat and got England through World War II. And you know, his creativity is really incredible too. Franklin once, Franklin Roosevelt once said of Churchill that he has a thousand ideas a day, four of which are good and that’s the kind of thing you see in these kind of leaders.
MS: You, you paint a contrast in the book between Neville Chamberlain, the man known and I guess the synonym now for his last name is appeasement and Churchill, Chamberlain being the mentally stable between the two. How do you think that it benefited the UK, the world at large that Churchill fought these demons during the course of his life?
NG: Well I think he really was the savior of the country and through the 1930s for about a decade to Chamberlain and Chamberlain’s mentor, the prior prime minister were you know, very stable, very rational individuals. Chamberlain had been a mayor of a major city in England, had been a very popular and successful leader of the conservative party, rank and file loved him, he rose through the ranks and during the peace and prosperity of the 1920s, he was great. In the 1930s, he was still popular. But he just ignored what was happening and when Churchill was finally made prime minister after a decade of being in the wilderness as he famously said, some of the people in his party were so nervous, they said you know, we can’t believe that now he’s gonna be the leader of this party. People didn’t think he could handle it, he was too unstable in a way they thought. But in fact when the crisis came, he was the most resolute and stable and clear leader that you could have and he clearly was the man that they needed and to your point, he had to suffer for about a decade or two through a lot of depression and a lot isolation in order to be available for England when they needed him.
MS: But Dr. Ghaemi, are you saying that because he was constantly dealing with as he put it the black dog, the depressive periods in his life, that he was by nature pessimistic, glass half empty, and when some saw the threat of the Nazis on the horizon, he assumed the worst because he suffered from depression where as a Neville Chamberlain, who was more mentally stable, didn’t appreciate what Churchill saw?
NG: Yes, you could put it that way, although I would adjust that a little bit. I would say that Chamberlain addressed the Nazi threat in a very rational way, assuming he was dealing with a very rational man you know, people said he was like an engineer trying to come to an agreement with Hitler. And that’s not the way Hitler worked, Hitler as you know in my book, I also wrote about Hitler having bipolar illness. Churchill, I don’t think he was just pessimistic, I think he was realistic and let me put it to you this way. There’s this research that’s called, that describes what’s called depressive realism and it shows then when people have mild depression and then they’re doing experimental tasks where you’re essentially assessing their ability to be aware of how much they control the environment. People with mild depression realistically lasses their ability to control their environment whereas people who do not have any depression at all, who are completely mentally healthy, overestimate their control of their environment. It’s called mild normal positive illusion. So it’s normal for us to be a little illusionary, to think we control things a little more than we do, to be a little more optimistic than reality warrants. But when you’re in a major international crisis and the lives of millions of people can fall in the balance of a little bit of positive illusion, it’s better to be a little bit depressed. That’s what Churchill was. It wasn’t that he was pessimistic, he was realistic.
MS: You have a chapter about the Kennedys, JFK in particular, Sickness in Camelot. Were his maladies strictly physical or physical and psychological?
NG: They were physical and psychological. So Kennedy is another example of someone that we can now speak about with a lot of detail. And in all these cases, I’m really not speculating, I, I have a good deal of written documentation, medical records, private letters, doctors’ reports and so on. In the case of Kennedy, about 40 some years after he died, his medical records were made available for the first time by his family very generously, everything is available now for scholars. You have to be a physician to look at them, but they make it available to you. And I, and I looked at them, I believe I’m the first psychiatrist to do so. And Kennedy’s medical records clearly state that he was diagnosed with Addison’s disease most of his adult life. This is the disease of the adrenal glands where you, the glands do not produce steroid hormones and if you don’t get steroid hormones, then essentially you can’t fight off infections and in the pre-antibiotic era you would die for that. The mien lifespan was about 30 years old. And it’s sort of like having AIDS, your immune system is not able to function because the steroids aren’t available. Kennedy was lucky in that in the 1940s, antibiotics got developed and then steroids were developed for the first time as a treatment, so through the late 1940s and into the, all the 1950s, he was being treated with antibiotics and steroids for repeated hospitalizations for Addison’s disease. One of the things that Addison’s disease can also do is it can cause depression because if you don’t have any steroids which are somewhat required for your mood, you can get depressed. And so, Kennedy had periods of depression in the 1950s where sometimes he was even suicidal and thought about drowning himself. Even in the White House, I discovered for the first time he was treated for depression with psychiatric medication briefly. And one other thing to add about it, steroids are needed for Addison’s, but as we know very well with athletes and so on, steroids can be abused because they make you feel more happy, more aggressive. In a word, they make you more manic, they increase your energy level and can cause manic states as well if their dose is high enough and in people susceptible to it. And Kennedy was abusing steroids and getting excessive amounts of them throughout the late 1950s and into the first two years of his presidency until his doctors finally got it under control and got him to use average amounts instead of high amounts before the Cuban missile crisis thankfully.
MS: I was just going to ask, because I don’t recall reading in the book a discussion of what went on during the course of the missile crisis and whether these factors played a role.
NG: Absolutely. Before the Cuban missile crisis in late October, in late 1962, Kennedy had been abusing steroids a lot. I’ve documented it in the book so the medical records, the doctors would document exactly how much testosterone she would inject into him each day and there’s, he was very erratic, he was very unproductive and unsuccessful as a president until then. But just before 1962, one of the White House doctors, Admiral George Burkley finally decided to intervene and got Robert Kennedy to agree with him. And without Robert Kennedy’s intervention, it wouldn’t have happened. They essentially did an intervention where they stopped President Kennedy from getting any injections from the other White House doctor who was his personal physician and he was flying in another doctor from New York who was injecting him with substances which they didn’t even know what it was. They stopped all that and they got him on very low dose pills. And about a month or so later, we were almost in the middle of a nuclear war and President Kennedy handled it with the resilience and the rationality and the realism that we all know probably saved the world from a war. And the next year, he totally changed the civil rights policies and became the very proactive and committed president that he was in that arena whereas before he’d been waffling on that topic for quite a while. So my view is that the great President Kennedy that we know in the last year of his presidency really came about because his steroid use became under control and then his moods stabilized and he you know, he became a more productive and effective leader.
MS: I have just two, okay, two or so final questions if I might, and thank you for being gracious with your time.
NG: You’re welcome.
MS: What about in a time of non-crisis? Do you want, I mean you’re making the argument and I think you’re making a very provocative, very effective argument that suggests that a person with some mental illness or mental abnormalities is actually well-suited in a time of crisis as a political or even military leader. But what about when it’s not a time of crisis?
NG: Right. So my argument is, is basically both-sided. I say that in a time of crisis, this is the kind of leader we need. But when it’s not a time of crisis, when the past predicts the future, when there’s peace and prosperity, when essentially you don’t really need a leader to do much, you just need them to be there administering things, supervising things, but not really being very creative or, or intervening, then the normal mentally healthy leaders are fine, people who have a little positive illusion, they’re optimistic, they have good social relationships, they get along with everything, they keep things moving smoothly. That’s fine under normal circumstances. The problem we have is that there always will be crises and then when the crises come, we usually have the normal mentally healthy leaders in power and they’re not there and able to manage it.
MS: Right, but you’ve, you’ve flipped my question on its head. I’m wondering what about the individual who has the issues that you’ve identified, are they similarly well-equipped to govern at a time of stability?
NG: Right, I think that’s a good point. I think that, that Winston Churchill for instance was not a good Chancellor of the Exchequer in the 1920s. He did a really bad job. He would have been a poor prime minister in the 1920s and he was a great one in the 1940s. I think the right person needs to be selected for the right time and it’s true, these kinds of leaders do not do well in normal times and often probably will cause more problems as opposed to being helpful when we are living in a time where there is no crisis.
MS: So you’re saying that they function better in a time of crisis than in a time of non-crisis.
NG: Right, in fact, if you look at the biographies of most of these leaders you know, you look at Lincoln before the Civil War, Churchill before World War II, William, General William Sherman before the Civil War, they were not successful, productive members of society most of their lives. It was only during the crisis that they flowered.
MS: I didn’t even get to Lincoln and I’ll leave that for readers. Okay. Here’s my final, here’s my final question for Dr. Nassir Ghaemi. Is the public ready to entertain this type of provocative argument given the stigmas that unfortunately are still attached to mental illness?
NG: Thank you very much for bringing out that point ‘cause I think that is the central point. And, and I think it’s the reason why this book, which I published a few years ago had a lot of positive comment and a lot of negative comment too. I think it touches on the fact that the public is really not yet ready to address, understand these issues dispassionately or clearly because we discriminate against people with psychiatric problems or mental conditions. And just like we discriminated, have discriminated against people on race, gender, and sexual orientation and still do, but we, we are more conscious of that and improving along those lines. We are not really conscious of how much discrimination we still have against psychiatric conditions and so these ideas seem really counterintuitive and really odd. But it’s partly because we’re ignorant, we don’t know that these conditions actually have positive aspects proven like I’ve described and it’s partly because we discriminate at an emotional level and we don’t really consciously, and we’re not consciously aware of how much we discriminate against these conditions.
MS: And yet the…
NG: So one of the things I hope, yes.
MS: I was gonna say, and yet the irony is that if these biases had been in evidence, if we had known about JFK what you know now, if, if individuals in the television realm had known about Ted Kennedy, if we’d known about Lincoln, if we’d known about Churchill, they wouldn’t have advanced to the position where they were of such immense benefit to society.
NG: That’s true and that’s why they hid all these aspects of themselves from the rest of the world and you know, it was understandable and it still is understandable. I think we need to get to the point now though where we can at least look back on these people who have been dead for 50 years or longer and honestly judge them, honestly talk about these aspects of them and then start drawing some conclusions about our current life and about ourselves and about the future and say you know what, let’s know about the medical and psychiatric histories of our leaders and, but let’s talk about it not in a pejorative negative way, but also look at the positive aspects.
January 6, 2018 on CNN
(Unfortunately, this transcript picks up mid-stream due to a technical difficulty)
NG: I organized a meeting at the American Psychiatric Association annual conference last year on the Goldwater Rule in which I argued against it and I think the problem with the rule is that it’s too absolute, not that it’s completely wrong but it goes too far. The problem with Goldwater, you well described and I think currently with President Trump, it is easy to use the epithet of narcissistic personality disorder as has been done by psychiatrists who mention to criticize him if one disagrees with him politically and I think that’s the problem that needs to be controlled. On the other hand, I think it, absolutely censorship doesn’t make sense either and that there are public behaviors and signs as well as documentary evidence like medical records that should allow for a legitimate psychiatric diagnosis to be made in public figures in some situations.
MS: I thought your book was provocative. I’m gonna read the thesis as you summarized it very early on. The best crises leaders are either mentally ill or mentally abnormal. The worst crisis leaders are mentally healthy. Explain.
NG: Well, the, the ideas in A First-Rate Madness come out of my own clinical experience as a psychiatrist. I’ve treated a lot of patients with depression and bipolar illness. And as a researcher in that field, where there’s evidence that there are some positive benefits to some psychiatric symptoms and conditions. For instance, people who have some depression are more realistic and more empathic towards others than people who have no depression who are mentally healthy. And people who have mild manic symptoms, mania being the idea is that you’re sped up in your thinking, movement, and feeling, people with mild manic symptoms are more creative and more resilient to stress than normal, mentally healthy people. And so these four traits of creativity, resilience, empathy, and realism which occur in manic depressive illness and depression and bipolar illness are seen in some of our best crisis leaders. And so in A First-Rate Madness, I basically describe the cases of some of those leaders, some of whom you mentioned like Churchill, Lincoln, and others who had these conditions, had these traits as part of their psychological makeup and also showed those traits as benefits of their leadership in times of crisis I should say, not always, but in times of crisis when you need them the most.
MS: Let’s run through an example or two.
MS: Winston Churchill, I consider myself a Churchill buff. I know that he was, had to deal with what he called his black dog, his depression. How did this impact Churchill?
NG: Well, so Churchill is a great case. He had very severe depressive episodes throughout his life. Sometimes he had trouble getting out of bed, going to Parliament, he had suicidal thoughts, would not stand close to balconies or near a railway platform with thoughts that he might jump in. And you know, in these cases we have other evidence that these are real diseases, for instance genetics. Churchill’s daughter committed suicide, he had many family members with psychiatric illness who were hospitalized. Now if you think about depression related to realism, the research involves different types of studies. For instance, a light coming on if you push a button and the researchers will control when the light comes on and people with a little depression have more awareness of their control over the light and there are more complicated studies as well. But people with a little depression are more realistic than normal people and Churchill in the 1930s, when he was very depressed, was quite realistic about the Nazi threat compared to the very mentally healthy normal leaders of his own conservative party and the other party as well as most of the population of Britain. That’s an example of where his depression enhanced his realistic leadership. I should mention…
MS: I wanna put on the screen if I might, Doctor, a quote from your book.
MS: I’ll read it aloud. Why not just exclude the mentally ill from positions of power? As we’ve seen, such a stance would have deprived humanity of Lincoln, Churchill, Roosevelt, and Kennedy. But there’s an even more fundamental reason not to restrict leadership roles to the mentally healthy. They make bad leaders in times of crisis just when we need good leadership most. Explain.
NG: So, if you think about the benefits of mild depression and mania, the flip side is that there are limitations to mental health. People who are mentally healthy and normal are not extremely empathic people. They often have some unrealism and psychologists called it mild positive illusion, an exaggerated sense of one’s self-worth, a somewhat elevated self-esteem. This is actually a good thing in normal life. You don’t wanna go through life feeling bad about yourself, but when you’re in power, when you’re in the bubble of power, this mild positive illusion can grow into what Lord David Owen, the British neurologist has called the Huber Syndrome and then the leader can get very unrealistic in a way that can be dangerous and you know, the examples I used historically are Neville Chamberlain during World War II, General George McClellan during the Civil War. Lord Owen revered to George W. Bush and Tony Blair as examples where this kind of hubris may have occurred in power. And Lincoln once said that if you wanna test a man’s character, give him power and I think this is the kind of idea that he, he was referring to.
MS: Are we ready for this as a society in 2018, are we ready for the findings of your book which argue that in times of crises, someone afflicted with a bit of mental illness might be better suited to ride out the storm? Because I worry about the stigma that unfortunately still applies to this subject matter.
NG: I totally agree and that’s part of the reason that I wrote the book. So I think one of the big problems with the Goldwater rule prohibition is that it actually enhances the stigma. The idea that it’s, that mental illness and psychiatric disease is so terrible we can’t even talk about it is part of the stigma and discrimination against mental illness in our society. We should be willing to make psychiatric diagnoses in our leaders and thereby not necessarily disqualifying them, but maybe even qualifying them in some ways. But keep in mind, in times of crisis these benefits occur. When things are fine and there’s peace and prosperity, mental health is fine, you don’t need to be realistic and creative and empathic, you just need to make the trains run on time. And if you’re a little too creative, you may make too many changes when you don’t need to. One of my concerns about current politics is that we are not in a time of crisis. Our economy is prosperous, we don’t have a major war, so if you do have a leader who has some manic symptoms for instance, that could lead actually to impulsive behavior that could actually create crises that need not occur.