Wednesday, August 24, 2011

Ghaemi's A First-Rate Madness: The Conversation Heats Up

This is my fourth installment in our conversation on Nassir Ghaemi’s “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” In times of crisis, Ghaemi tells us, we don’t send in someone chronically normal to do a crazy man’s job.

In essence, when the situation calls for seasoned lunatics such as Lincoln and Churchill, the worst thing that can happen to us is to entrust our fates to the likes of George W Bush and Richard Nixon.

The chronically normal may be okay for normal times, Ghaemi lets us know. But when the going gets tough, the normal wimp out. In these situations, their brains and life experience let them down. Creative solutions fail to present themselves, they become irrational, they crack under pressure, they make appallingly bad decisions.

By contrast, the crazy ones (at least those with the right kind of crazy) rise to the occasion. Not only do creative solutions come easily to them, they view events with far greater realism and are able to mobilize others to their cause. Plus - remarkably - they are the ones who display grace under fire. They are the ones as cool as a cucumber.

Wait a second! you say. George W and Nixon had to have been crazy. How else can you explain their inexcusably bad leadership?

Easy, says Ghaemi in so many words. They were normal.

And Hitler?

Okay, Hitler requires some explanation. The short version, according to Ghaemi, is that Hitler lost his marbles only after a quack physician put him on a mega-cocktail of barbiturates, amphetamines, and steroids.

This makes no sense, you say.

Right, absolutely. Moreover, we can say Ghaemi is being highly speculative and interpretative, and is exercising great selectivity in his case studies. Moreover, it’s easy to retrospectively go back over old facts and find any pattern you’re looking for to fit your hypothesis - a point I ironically learned from Ghaemi himself when he gave an APA talk a number of years back on the dangers of spinning clinical drug trials data.

Indeed, two NY Times book reviews take Ghaemi to task for precisely these and other points.

“Practicing history without a license,” is Thomas Mallon’s verdict in the Aug 19 NY Times Sunday Book Review.  “Unrealistic in his beliefs,” is how Janet Maslin concludes her Aug 10 NY TImes review.

Okay, Mallon is perfectly correct when he calls out Ghaemi for his superficial gloss of Harry Truman. Says Mallon:

Ghaemi even argues that the successes of “levelheaded” Harry Truman don’t refute this part of his thesis, since Truman wasn’t “handling major crises” during what Ghaemi seems to regard as an eight-year cakewalk from Hiroshima through Korea.

I admit to missing this completely. Otherwise, I would have cited Ghaemi with a speeding violation. Ghaemi glosses over Ike in a similar fashion. Ironically, Ike experienced depression earlier in his career and he doesn’t get anywhere near the credit he deserves for his skillful management of the Cold War.

Both the Ike and Truman examples occur in one obviously hastily written paragraph on page 223 of the book, and my guess is Ghaemi probably wishes he struck it out. Indeed, Maslin, sensing weakness, plants her dagger in precisely the same spot:

He even navigates entirely around figures who do not fit any of his theories. Ronald Reagan is branded [as normal], but “Reagan never faced a Cuban Missile Crisis.” Dr. Ghaemi drops his name, but can’t pigeonhole him at all.

It would be easy to dismiss Mallon and Maslin as myopic scribblers who know nothing about mental illness and totally missed the point, but then I would have to tar some of my readers - people who clearly know what they are talking about - with the same brush. Says Gina:

It seems to me that all sociopathic leaders (Stalin, Idi Amin, etc.) started out somewhat "normally" and often charismatic.

And what kind of metrics were they using to gauge "normal" back then? If you weren't yelling gibberish and frothing at the mouth, you were probably normal. If you could think rationally, do math problems, etc. you were probably normal.

In another post, Gina says:

John, after reading a few chapters of the book, I gotta say - I really agree with Thomas Mallon's review.

I hear you, Gina. Ghaemi is presenting a proposition that is not only difficult to swallow, but may in fact be completely wrong. Moreover, Ghaemi is on shaky ground when he spins the likes of FDR, JFK, and MLK as being on the right side of crazy.

Indeed, we could take every example of Ghaemi’s and argue an equally valid case the other way, namely that George W Bush was crazy, Lincoln was normal, and so on. That’s why I find history so fascinating. There are no absolutes. Wouldn’t it be great if we had a population intelligent enough to support history bars, modeled on sports bars, where people could walk in off the street and argue over a few beers why the hell George McClellan proved himself so indecisive and inept at Antietam when he knew Lee’s battle plan in advance?

Oops - Ghaemi asks precisely that very question in his book. The whole normal-crazy thing again.

I would argue that McClellan was a narcissist rather than normal. Ghaemi rejects the whole principle of narcissism, but it’s not a matter of who is right and who is wrong. There are no right or wrong answers, here. Only interpretations.

This is where I was coming from when I introduced Ghaemi’s book as a conversation. And starting the conversation is Ghaemi’s big issue - namely, that normal isn’t what it’s all cracked up to be. And that crazy can be good.

I have been writing about this for the best part of 12 years. It’s a very tough argument to make, particularly when your illness has the upper hand or if you are an innocent bystander who desperately wants your son or daughter or sibling or loved one back.

Last year, I keynoted the Kansas State DBSA conference in Manhattan. Someone asked me a question about famous people with mental illness.  

"I like to say to people," I replied, "we give you the gift of civilization and how do you treat us? You marginalize us."

I went on to say:

We discovered fire. I don't care if nobody wrote this down. Anyone crazy enough to go out into a burning forest and bring a flaming twig back inside a cave was not normal, was not thinking linearly, okay?

And just everything, from discovering America to painting the Sistine Chapel to writing Beethoven's Ninth to great poetry, great works of literature, to Isaac Newton, great works of science. I mean, literally, every field of human endeavor, we brought the world the gift of civilization and we get marginalized.

Indeed, if it weren’t for the crazy people, we’d still be shivering in caves. We need to acknowledge the gifts within us, to shout it out to the world: I’m crazy and proud.

Society has a way of viewing normal as all-good and mental illness as all-bad. When bad things happen, be it an individual in a shopping mall running amok or someone with too much power starting a war, we look for explanations in the DSM.

Dr Ghaemi lets us know this is highly stigmatizing. Absolutely. No question about it. Quibble all you want with Ghaemi, but let’s not lose sight of the big picture.

As I said, this is a conversation - let’s keep it going. Let’s keep arguing ...

Previous posts:

The Normal Paradox
Normal: It Ain’t What It’s Cracked Up to Be
Reckoning with Evil 


Gina Pera said...

Very interesting, John.

One clarification: I never claim to know what I'm talking about. :-) Like everyone else, I just have my opinions.

I just can't say I'm swayed by Ghaemi's arguments, because I find them so poorly supported and his premises so questionable.

Do I agree that "extreme" human qualities have enriched our world? Of course!

Do I want someone who is not thinking clearly or rationally running our current world-as-key-of-TNT? Of course not!

Gina Pera said...

KEG, i meant KEG. Not key. Geez.

Addy Bell said...

When I read in a review that Ghaemi considered MacClellan to be "normal" I fervently hoped that the reviewer was wrong. I have never, anywhere, at any time, heard George MacClellan referred to as "normal". The dude was the kind of head case that makes the rest of us look bad.

As for The Conversation, the one I'd like to have is about resilience. Some people who have a genetic predisposition toward mental illness never develop it. Why? Some creative types (likely to have low latent inhibition, like many mentally ill folks) never develop mental illness. Why?

Speaking for myself, everything I've accomplished (and most days that doesn't look like much) has been accomplished *in spite* of my ADHD and mood disorders. I'd like to think that there are ways to identify and protect sensitive people -- and for us to learn to protect ourselves -- so that we can enjoy our gifts without being done in by our disabilities.

John McManamy said...

Hey, Addy. I had the same reaction as you to McClellan as normal. The way he treated Lincoln indicates he definitely had Axis II stuff going on, and Lincoln's aides urged he fire McClellan for his impertinence.

But Ghaemi does make a case that McClellan was a brilliant career military man - that is until he actually had to lead armies into battle, when he couldn't even win at Antietam knowing Lee's battle plan in advance.

Still, he was a head case to me.

Ghaemi talks quite a bit about resilience in his book, which is worth raising in a future post. In many cases, it appears that early stress and trauma can be protective against later life catastrophes.

It works the other way around, too, but Ghaemi doesn't go into that. In any case, good topic. Thanks for bringing it to my attention.

As to your last point, re self-protection - my entire life is organized that way. I work from home, I'm very careful about who I admit into my life, I take mental health breaks, and so on. That way I can function and even - on occasion - thrive.

We really do need need to protect ourselves.