Nassir Ghaemi Uncovers A First-Rate Madness

Before pushing on to the problem of Poland, Adolf Hitler had to solve “the problem of pep.” Of the two, it proved the trickier. The monster of Munich was not a morning person. “With constant anxiety and frequent mood episodes,” Nassir Ghaemi writes in A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness (Penguin Press, 352 pages, $27.95), “[Hitler] had developed, like Churchill, reversed sleep cycles. He stayed awake late into the night, talking and working inordinately, but slept each morning until noon. Hitler wanted morning pep and evening sleep. Morell had just the thing.” Morell was Hitler’s physician, Theodor Morell, a peddler of “magic injections” to patrician Berlin. Just the thing was intravenous amphetamine. The era of pep on demand had dawned.

That was 1937. By 1941, “Hitler was constantly taking three kinds of psychoactive drugs: opiates, barbiturates, and amphetamines,” along with “intermittent anabolic steroids.” These elixirs certainly routed the Hitlerian torpor, but they created other problems. The lie-abed of old had been reborn an ogre of vigor. “On one occasion, in December 1942, [Hitler] shouted nonstop for three hours.” Hitler’s speech stampeded, yet went nowhere. A mood of high-strung vagueness engulfed him. He was “obsessed by details, telling his commanders what to do at every turn,” yet “he couldn’t concentrate, he was indecisive, and … he was absent-minded.” As his Reich fractured, the Führer’s drug use came into flower. “In his final two years,” Mr. Ghaemi writes, “Hitler probably never experienced a day of normal mood.”

As a picture of Hitler, this has precedents. His amphetamine use, like the flux of his moods, was documented long ago. The picture has, however, been given a strange new frame. For Mr. Ghaemi, Hitler’s downfall is not a story of derangement augmented by drugs. It is, paradoxically, a story of derangement marred by drugs. “Up to 1937 … [Hitler’s] moderate bipolar disorder influenced his political career for the better—fueling his charisma, resilience, and political creativity. After that date, the harmful effects of daily intravenous amphetamine … worsened his manic and depressive episodes, impairing his leadership skills with catastrophic effects.” This is not an endorsement of Hitler’s pre-amphetamine politics—Mr. Ghaemi is not a Nazi sympathizer—but a theory of why they thrived. Hitler’s bipolarity had been an asset, yet a precarious one. Speed turned it to poison.

Of course, laying Hitler’s political gifts at the foot of his madness is nearly as troubling as praising him, and also raises difficult questions. Is low-level lunacy really a virtue in a leader? Will it always undo those, like Hitler, who try to tame its vicissitudes with treatment? “This book argues that in at least one vitally important circumstance insanity produces good results and sanity is a problem. In times of crisis, we are better off being led by mentally ill leaders than by mentally normal ones.” Answers: Sometimes, sometimes.

Hitler is one of an ensemble cast. A First-Rate Madness is a sophisticated work of psychology, but it is also a gossipy work of celebrity history, a who’s who of the eminently unhinged. “You sometimes find something pretty good in the lunatic fringe,” as Franklin Delano Roosevelt put it. What you usually find is sex. F.D.R., America’s fizziest president, philandered right through his infantile paralysis. In him, Mr. Ghaemi diagnoses hyperthymia—a condition of perpetual faint mania. John F. Kennedy receives the same diagnosis, and we duly see him driving fast and talking faster, capering with “Fiddle” and “Faddle” in the White House pool. Ted Turner too was hyperthymic; Ted Turner too slept around. So did Mahatma Gandhi and Martin Luther King. “We are all worms,” said the bipolar Winston Churchill, “but I do believe I am a glowworm.” These glowworms rutted like rabbits.

“I am now the most miserable man living,” Abraham Lincoln wrote in 1841. According to Mr. Ghaemi, this is a kind of boast; Lincoln’s greatness was nourished by his glumness. “Lincoln’s depression enhanced his political realism,” he writes. Mr. Ghaemi identifies four categories of aptitude in which the compos mentis lag the mad: resilience, creativity, realism and empathy. A panoply of studies supports these claims. The mentally healthy tend to be overconfident, uninspired, thin-skinned and soundproofed from the suffering of others. Writes Mr. Ghaemi, “Depression deepens our natural empathy, and produces someone for whom the inescapable web of interdependence … is a personal reality, not a fanciful wish.” This is the theory of depressive realism. Those who see the glass as half empty may simply have better eyesight. Normality is a form of unreality.

To all this, however, Mr. Ghaemi appends two whopping provisos. The first is that mentally unbalanced leaders can succeed only in times of crisis. “In these hard times,” as William Tecumseh Sherman said in 1861, “it is hard to say who are sane and who are insane.” As the crisis ebbs, and the distinction between sanity and insanity reboots, the latter loses its usefulness. The trajectory of Churchill, who prospered in wartime but floundered in intervals of peace, exemplifies this.

The other proviso is a paradox, which Mr. Ghaemi terms “The Goldilocks Principle.” The Goldilocks Principle states that insanity is beneficial only in moderation. Too much insanity—outright psychosis—is debilitating. Too little does nothing.

Yet insanity is excessive by definition, a lawless swerve from the norm, and anything less is going to be hard to distinguish, as it were, from mere distinction. For instance: “It takes more than a typical amount of self-awareness,” Mr. Ghaemi writes, “to realize that one is wrong and to admit it.” This is true. Yet it seems unlikely that self-awareness must travel to the cusp of psychosis before it can admit to error. Mr. Ghaemi assures us we are drinking moonshine, but it tastes like mostly water. “[F.D.R.] knew only that people were hurting; he knew what it was like to hurt; and his personality would not allow him to sit still.” The attempt to make mild abnormality look insane has the unintended effect of making insanity look banal.

The writing thins under the strain of this contradiction. “Hyperthymia can lead to much success, but at the cost of much failure.” “They were movers and shakers, literally, not just in the sense of the cliché.” “Having survived this far, he didn’t intend to surrender to other dogs, whether Hitler or Mussolini.” “Like his hero Winston Churchill and his predecessor Franklin Roosevelt, John Kennedy never gave up.” That last sentence is only one never away from hagiography. All the rah-rah quickly gets ho-hum.

But Mr. Ghaemi is smarter than this, and his description of the homoclite, or “rule-follower”—his chosen term for the mentally normal—lays bare the thorn that has snared him. Homoclites, we are told, are “very, very middle class,” “middle-of-the-roaders in every way.” They are bland, affable, docile. “[Tony] Blair came from classic homoclitic stock, solidly middle class, soundly religious,” he writes. So did George W. Bush, Richard Nixon and Neville Chamberlain.

What Mr. Ghaemi means by homoclite isn’t sanity. It’s mediocrity, middlingness. He opposes his moderate madmen to it. “An excess of virtue is a vice,” Mr. Ghaemi writes, “if we recall that the classical Greek concept of virtue … involved moderation.” The problem is that a first-rate madness and a second-rate sanity look alike. The difference between moderation and mediocrity may be the world in a grain of sand, but they are also approximate synonyms. Both are just wide of the middle. And though he tries bravely, Mr. Ghaemi cannot discriminate between them, either. “Asked years later whether FDR’s polio affected his politics,” Mr. Ghaemi writes, “Eleanor summed it up well: ‘He would certainly have been President … but a president of a different kind.” We can do no better than Eleanor.


Nassir Ghaemi Uncovers A First-Rate Madness