Tuesday, August 30, 2011

The Ghaemi Conversation: Why We Need to be Asking the Questions

This is my fifth installment in our conversation on Nassir Ghaemi’s “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” My previous post made note of the fact that two myopic scribblers posing as NY Times reviewers trashed Ghaemi for “practicing history without a license” and as being “unrealistic in his beliefs.”

The trash-talkers, needless to say, entirely missed Ghaemi’s point: Namely, that “normal” is highly over-rated and that (the right kind of) crazy can be an enormous asset when the chips are down. This is something I have simultaneously known all along and has never occurred to me. Then I opened Ghaemi’s book, and - pop! - the two contradictory halves of my brain reconciled.

I have devoted the better part of 12 years to urging my fellow bipolars and depressives to acknowledge the strange gifts that our conditions confer. In fact, crazy often leaves normal for dead. If you have trouble with this proposition, try imagining what the ceiling of the Sistine Chapel would have looked like with someone chronically normal up there on the scaffolding.

My guess is two coats of beige.

Mind you, normal looks pretty good when our illness has the upper hand. But over the long haul, trial by ordeal has a way of imbuing us with the kind of strengths that those the pathetically normal cannot even begin to comprehend.

Fine, I hear you say. A little bit crazy may be fine for artists and eccentric capitalists, but for high political office? With the world on the brink of economic collapse? Surely, the situation calls for someone with an even temperament in the Oval Office, right?

You tell me. No-drama Obama has been in the hot seat for nearly three years. Are you happy?

Meanwhile, the current crop of Republican Presidential candidates - declared and undeclared - are vying for who can come across as the most crazy. What is wrong with this picture?

Do you see in our future the end of the world brought to you by Fox News, with Sean Hannity and Bill O’Reilly congratulating themselves on saving us from the evils of big government?

Can our past at least tell us something about what is going on? Funny you should ask. Dr Ghaemi serves up Lincoln and Churchill - two well-documented depressives, the latter slightly bonkers - who admirably rose to the occasion in times of crisis. Likewise, JFK and FDR leaned more toward the abnormal than we tend to acknowledge.

But that is only half the story, according to Ghaemi. Hitler, it turns out, was far more normal than we give him credit for, at least until 1937 when his physician put him on a mind-altering meds cocktail (don’t get me started on meds compliance). Meanwhile, beneath the whacko exteriors of Nixon and George W Bush lurked temperaments bordering on the pathologically sane.

Six years ago, at the American Psychiatric Association’s annual meeting in Atlanta, I heard Nobel Laureate Eric Kandel explain how his exposure as a boy in Vienna to the brutalities of Nazism got him started in psychiatry. Psychoanalysis, which passed for psychiatry back then, offered "perhaps the only approach to understanding the mind, including the irrational nature of motivation and unconscious and conscious memory."

"How,” Dr Kandel asked in his Nobel autobiography, “could a highly educated and cultured society, a society that at one historical moment nourished the music of Haydn, Mozart, and Beethoven, in the next historical moment sink into barbarism?"

Could normal be part of the problem? suggests Ghaemi in his own way. Can so-called normal individuals and whole populations even, in times of uncertainty and hardship and crisis, subscribe to crazy beliefs, make irrational decisions, and sanction unspeakable acts?

This is the kind of discussion we need to be having as the Presidential campaign kicks into gear.

Next: The NY Times refuses to take up this discussion.

Previous posts:

The Normal Paradox
Normal: It Ain’t What It’s Cracked Up to Be
Reckoning with Evil 
Ghaemi's A First-Rate Madness: The Conversation Heats Up

Thursday, August 25, 2011

Relationships: Dealing with Life's Little Surprises

On Thursday, Sept 8, I will be giving a talk here in San Diego to the International Bipolar Foundation. My presentation will be on relationships, which I am an expert in, having been in and out of two marriages. Following is a sneak peek, from a segment of my planned talk ... 

Let’s see if we can make sense out of a universe that makes no sense. For that, we go back to the universe inside our heads. The new brain science is telling us a lot about the dynamics of relationships.

The back end of the brain - the primitive reacting parts:

The front end of the brain - the thinking and deciding parts:

Now let’s add an extra element or two to the picture. Look up at the ceiling. This represents life’s little surprises. This is where two tons of crap falls from. Look at the floor. Two tons of crap have just landed. This is what the brain has to deal with. I bet you're wondering what two tons of crap looks like:

So here we are minding our own business. Wow! Two tons of crap just dropped from the sky. How is the brain supposed to deal with two tons of crap?

Okay, here’s the deal. It takes time for the cortical areas of the brain to process information. Very complex. Too much time. And often we can’t afford to wait. We need something simpler, much faster.

So the back end of the brain takes charge. The primitive part of the brain, the reactive part of the brain. This is the limbic system, involved in fight or flight. So, basically, when we perceive anything strange or stressful, we’re wired to freak out first and think later. If it’s a skunk walking in through the cat flap this is a perfectly normal response.

Now let’s add an extra element to this. Namely another person in the room. Two people in the room with two tons of crap.

So now we have two people who are not thinking. How do you think these two individuals are going to get along?

Okay, let’s assume one of the individuals is thinking with the front end of their brain. Do you think we will have a better outcome?

We all make this mistake. We actually think we can reason with someone in this state. Basically, your cortex is talking to the other person’s amygdala. I ask you - What kind of a result are you expecting from that?

Ideally, we want to be engaged cortex to cortex.

But there is a catch. The front end of the brain can’t make a decision without some input from the back end of the brain.

And, of course, heart enters into it.

Emotions give meaning to experience. We need to honor our own emotions. We need to honor the other person’s emotions.


All of you are invited to my talk. For further details, click the link below:

International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

Thursday, Sept 8
5:30-6:00- SOCIAL
6:45-7:00- Q & A
Sanford Children's Research Center, Building 12
10905 Road to Cure, San Diego 92121 

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 

Monday, August 22, 2011

Choosing a Partner: Good Luck Deciding

On Thursday, Sept 8, I will be giving a talk here in San Diego to the International Bipolar Foundation. My presentation will be on relationships, which I am an expert in, having been in and out of two marriages. Following is a sneak peek, from a segment of my planned talk ... 

Last year, I decided to give internet dating a go. But there are limits in our capacity to think things though, which I discovered once I started checking out the available women on this particular dating site.

My prefrontal cortex simply refused to cooperate. It’s kind of like shopping for a car. We may think we’re smart, but ultimately we’re going to pick the model with the best cup-holder.

That’s the way our brains work. When all is said and done, it is the ventral tegmental area (VTA) that rules, not the parts of the brain we actually think with. The VTA is the dopamine-sensitive region in the midbrain that mediates pleasure and reward.

Helen Fisher of Rutgers has done studies on the brain in love and lust, so I’m not just making this up. Also, Jonah Lerher has written an excellent book, How We Decide.

So, using the new car example - Never mind price and practicality and all that, says the VTA in effect. Get the car with the best cup-holder.

The thinking parts of the brain are only there to rationalize the choice your VTA has already made. So - hopefully, when you get your new cup-holder-on-wheels back home, you find it comes equipped with things like seats and an engine that works.

This is why my best-laid plans for choosing a woman online were doomed from the start. The prefrontal cortex is simply incapable of making up its mind. It needs input from the emotional parts of the brain.

Which woman? The tree surgeon who has just finished reading Joseph Campbell or the martial arts black belt who teaches drama at a community college? See what I mean?

So we have to compensate. There is a very technical scientific term for how men and women decide who is right for them:

Anyway, here I was with a gridlocked brain. I needed visual - emotional - cues. "Tomatoe Girl!" something in my head cried out. This was a woman with no obvious interests whatsoever who spelled tomato with an e. Oh crap, I could only think.

"A wop-bop-a-loo-bop!" my VTA was screaming. My poor prefrontal cortex didn't stand a chance.

Let me back up a bit:

Other stuff was also going on in my brain. Over in the back end of the brain, my amygdala - fear central - was in league with my hippocampus and other centers of ancient memory, cranking out malicious sound bites for the amusement of my inner mother.

Suddenly, I was that short skinny nerdy high school kid with glasses at my first high school dance, on the gymnasium floor, Bobby Vinton's "Blue Velvet" crackling out of a crappy PA system, trying to summon the nerve to ask Marie Kapinsky to dance.

Meanwhile, over in the front end of the brain:

The brief my prefrontal cortex had assembled was bullet-proof: The men these women date own their own homes. They drive in cars with Bose Surround Sound.

But I don't want to die a virgin! was my best defense. Okay, that wasn't exactly accurate, but I was stalling for time. In desperation, I summoned "Tomatoe Girl," the woman with no obvious interests who couldn't spell tomato.

Instantly, the tenor of the conversation changed. My VTA was calling the shots. My amygdala and its henchmen were nowhere to be found.

She doesn't know how to spell tomato, my prefrontal cortex cut in.

And that's why she won't complain when I show up in a car that doesn't have a working radio, my same (and now dueling) prefrontal cortex shot back.

Weighing, measuring, weighing, measuring ...

Nothing good ever came from thinking with your favorite organ, my dueling prefrontal cortex let me know.

True, my dueling prefrontal cortex acknowledged. Bad marriages, failed relationships. I needed to change my pattern. In some way I couldn't comprehend but knew was true, Tomatoe Girl was part of my old pattern. On the other hand:

Who is the woman I want to be snuggled up with on the sofa right now?

Oh, crap! My entire prefrontal cortex was now in thrall to my VTA. Already, it was cooking up images of the two of us - me and Tomatoe Girl - curled up in a comfortable corner of her motor home (the corner that didn't need to be jacked up), sipping Jack Daniels from the same bottle and viewing reruns of NASCAR.

Fortunately, this is where choosing a soul-mate online differs from buying a car. Unlike my cup-holder on wheels, I couldn’t just take Tomatoe Girl home with me.

Thank heaven for that. My brain is not set up to look out for myself. Neither - I submit - is yours.

Anyway, the moral to this story: Good luck in making a decision.


All of you are invited to my talk. For further details, click the link below:

International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

Thursday, Sept 8
5:30-6:00- SOCIAL
6:45-7:00- Q & A
Sanford Children's Research Center, Building 12
10905 Road to Cure, San Diego 92121 

Tuesday, August 16, 2011

Reckoning with Evil

This is my third installment in our conversation on Nassir Ghaemi’s “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” In our previous two pieces, Dr Ghaemi indicated he is no fan of normal, at least not in crisis situations that call for individuals (such as Churchill) with at least some practical experience in crazy

In my second installment - Normal: It Ain’t What It’s Cracked Up to Be - I mentioned a study reported by Dr Ghaemi that found that so-called mentally healthy individuals suffered a bad case of average-itis. These well-adjusted individuals tended to fit in rather than rock the boat. Not that there’s anything wrong with that. It’s just that, in a crunch, you don’t send in a normal person to do a crazy man’s job.

So far, so good. But in our first installment - The Normal Paradox - I also outlined an extremely contentious proposition advanced by Dr Ghaemi, one having to do with “normal” as a strong contributing factor to Nixon and George W Bush making bad decisions. In other words, humans are perfectly capable of exercising appalling judgment on their own account, with no assist from any condition with a DSM pedigree.

But Nixon had to have been crazy, you may well counter. Indeed, maybe he was. But the point is that he didn’t have to be, and neither does anyone else. Normal people have committed the worst atrocities imaginable. Enter Ghaemi’s next case study, Adolph Hitler.

First the black box warning: Reconceptualizing Hitler is bound to raise intense reactions. I totally respect that. I’m not even asking you to keep an open mind.

Way way back, on mcmanweb, I reviewed Hershman and Lieb’s “Brotherhood of Tyrants,” which attributed Hitler’s atrocities to bipolar. No, I said in effect. True, the evidence for Hitler’s bipolar is compelling, but not everyone with a mood disorder invades Poland. It had to have been sociopathy.

Not really, says Dr Ghaemi. We start with impossible-to-ignore documentation of Hitler’s depressions and (hypo)manias, but until 1937, Ghaemi contends, Hitler’s condition “seemed manageable.” That changed when he started to take amphetamines.

In 1937, Hitler began treatment with a new personal physician, Theodor Morell, who stayed on till nearly the end. Dr Morell prescribed amphetamines for depression (and a narcotic and other drugs for GI problems and barbiturates for sleep). Confidantes such as Hess and Himmler immediately noted the change in their boss’ behavior. In 1941, there is evidence Hitler was taking amphetamines intravenously on a daily basis, supplemented by oral doses. By 1943, he was receiving multiple daily injections.

Dr Ghaemi points out that oral amphetamines cause mania in about half of individuals with bipolar, with a much greater certainty with intravenous injections. Rats are deliberately injected with amphetamines to produce an animal model of psychosis. As thoroughly odious has Hitler had been, Ghaemi observes, citing Bullock, he was a realistic and astute politician. Moreover, he hadn’t invaded any countries, nor had he turned genocidal. As Ghaemi describes it: “Morell lit a fuse that exploded the entire world.”

Thus, up to 1937, Hitler’s bipolar benefited him in a way that influenced his rise to power, “fueling his charisma, his resilience, and political creativity.”

Ghaemi acknowledges that Hitler had always been an angry man, but that he had generally been “courteous and proper” in social settings. By 1942 (after the war had turned against him) Hitler was routinely screaming at his generals. Whereas he used to have no trouble delegating authority, now he became obsessed with details. His doctor only made things worse by intensifying the quack treatments.

Okay, so how do we account for Nazism in the first place? Or, for that matter, any evil?  What about Hitler’s henchmen? How sick were they?

After the War, Ghaemi tells us, the Allies put two dozen high-ranking Nazis  (including Goering and Ribbentrop) through extensive psychiatric evaluation and psychological testing, which went on for two years. The evaluations revealed that these men were normal. Goering, for instance, according to one investigator, had a “normal basic personality,” though “he was cynical and filled with mystical fatalism.”

Hitler’s criminals went to their deaths, totally impenitent, very pleasant people to talk to, righteous to the end.

Are we ever going to understand evil? Probably not. Are we making a serious mistake always associating evil with crazy? Definitely so. Evil, unspeakable evil, lurks everywhere. Crazy is not a requirement. Normal works very well with evil. Until we come to terms with this shocking fact of life, evil will continue to flourish, barely contested. That’s been our long past. Our futures may turn out short. 

Quick Update

Yes, I'm still here. Yesterday, I drove a visiting family member to the airport. Tomorrow, I'll be the one flying out - to Sacramento and three days of NAMI CA. I'm hoping to get off a couple of blogs on the road. Plus I have a whole backlog of cool stuff to write about when I return. In the meantime, many thanks for your loyalty and support.

Tuesday, August 9, 2011

Normal: It Ain't What It's Cracked Up to Be

This is my second installment in our conversation on Nassir Ghaemi’s “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” (See The Normal Paradox.) Dr Ghaemi is by no means the first to comment on the positive association between manic-depressive tendencies and outstanding achievement, but he goes much farther by calling “normal” into question.

Basically, Dr Ghaemi is asking: If the right kind of crazy is optimal in times of crisis, what does that say for normal? Can’t we at least regard normal as serviceable in a pinch? No, is his unequivocal conclusion.

The basic fallacy about normal, if I am interpreting Dr Ghaemi correctly, is that this condition (yes, let’s call it a condition) leaves a lot to be desired, in the first place. Dr Ghaemi’s starting point is a study from about 50 years ago by one of Freud’s last disciples, Roy Grinker.

Dr Grinker screened a group of 343 college-age men, out of which he selected 65 he deemed to be in the middle of the mentally healthy range. Based on subsequent interviews, Grinker came up with a detailed list of mental health attributes for these “upright young men.”

There was, however, a major catch. These paragons of mental health suffered a severe case of “average-itis.” They had slightly above average IQs, their grades were average, and they were not leaders on the team sports they had played in high school.

In effect, their main positive attribute was they played well with others. Dr Grinker came up with the term “homoclite” to describe these drearily normal individuals - “those who follow a common rule.” Their goals were to fit in, do good, and be liked. Apparently they would grow up to become part of the “great silent majority” that Nixon infamously pandered to.

As Dr Ghaemi points out in his book, Dr Grinker’s homoclites represented the norm (a statistical average) and normal (an absence of illness), but hardly an ideal.

Which brings us to the $64,000 question ($523,412.54, adjusting for inflation): When the chips are down, would you truly want one of Grinker’s homoclites as your President or Prime Minister?

Or would you would feel more comfortable with someone who had been temporarily expelled from school, such as JFK?

Basically, Dr Ghaemi is validating what many of us have felt all our lives, namely: those of us who are not normal have no desire to become normal. True, we don’t want to be severely depressed or manic, either, or for that matter overly anxious or cognitively impaired or just plain feel miserable inside our own skins. We want to be better, to be ourselves.

But normal? No way, normal sucks.

I’ve related numerous times here on Knowledge is Necessity a knock-me-over-with-a-feather moment from a grand rounds I delivered three years ago to a psychiatric facility in Princeton, NJ, but it bears retelling and reinterpretation. Obviously, the individuals I was addressing were considerably smarter than your average homoclite. Nevertheless, we are living in a homoclite culture that apotheosizes normal. Just about everyone is in on the act. Just about everyone believes in the myth.

So here I was, trying to get through to a bunch of what I now know to be accomplished homoclites.

"Keep in mind," I said, "a lot of us view the world through the eyes of artists and poets and visionaries and mystics. Not to mention through the eyes of highly successful professionals and entrepreneurs. We don't want to be like you."

It was as if I had let rip a roof-rattler and everyone was too polite to laugh. Then I blurted out: “To me, you all have flat affect.”

Kelvin grade frozen stony cold silence.

Suffice to say, my talk was a disaster.

I naturally assumed that I had been wasting my time trying to get through to people heavily invested in the myth of normal. But, after reading Ghaemi’s book, maybe something else was going on, as well. Maybe these individuals suffered basic deficits in the empathy department.

There is a biological component to empathy, but a lot of it has to do with getting blindsided out of nowhere by whatever life has decided to throw at you. Picking up from Ghaemi’s account:

Franklin Roosevelt had a glorious future ahead as a homoclite golden boy. Mind you, FDR was no dullard. Quite the opposite. According to Ghaemi, FDR was an “omnivore and an innovator,” with certain manic tendencies consistent with a “hyperthymic” temperament. But, “until 1921, Franklin Roosevelt had led a charmed life.”

Everything changed at age 39, when he was felled with polio. He returned to public life three years later a different man. According to longtime friend and political associate, Frances Perkins, recounted by Ghaemi, “an untried flippant young man” underwent “a spiritual transformation,” emerging “with humility of spirit and with a deeper philosophy.”

Years later, Eleanor Roosevelt would remark: “He certainly would have been President, but a different President.”

So here I was, in Princeton, talking to a bunch of mental health professionals who couldn’t see the merit in even “a little bit” crazy, who could not even relate to the possibility that a good many of us do not want to be like them. That, to people like us, normal sucks.

Naturally, I could understand why they wouldn’t want to be like me. But could they not, at least, validate my creativity and other traits the way I value their stability? Could they not acknowledge that maybe they, too, could benefit from some of my strange gifts?

Introspection, enthusiasm ... empathy?

Monday, August 8, 2011

The "Normal" Paradox: Is Obama Mentally Unfit to be President?

Okay, before we start, let me make it clear: This is my thought. It belongs to me. I take full responsibility.

But the book I just finished reading, “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness” by Nassir Ghaemi, has cleared the path for me to jump to this conclusion.

Dr Ghaemi is a professor of psychiatry at Tufts University. The book is hot off the press.

I will have much more to say on “A First-Rate Madness” and Dr Ghaemi in a bit. Let’s just say for now that this is the book of the year, that every word will give you something to think about (even the prepositions), that you need to buy it right now, that you need to read it cover to cover, and that you need to discuss it with everyone who knows how to breathe.

Okay, let’s get started:

Soon after election day 2008, I posted a blog piece on HealthCentral entitled, The Presidency: Temperament is the Real Issue. As you will recall, at the time of the election, the world was in economic free-fall. But the real concern was not the economy so much as which candidate possessed the best temperament to handle the crisis.

Virtually every babbling head at the time weighed in on the topic. Joe Klein, writing of Obama in Time magazine, observed: "His preternatural calm has proved reassuring ... "

By contrast, during the campaign, voters were unnerved at the spectacle of an impulsive and mistake-prone John McCain barely able to contain his rage. As I noted in my blog piece:

Obama was seen as "unflappable," in short, the type of person you would want first on the scene if you happened to be pinned under a car about to explode.

Okay, I take it all back.

A year after Obama took office, Jacob Weisberg, in a piece on Slate subtitled “How Obama's cool, detached temperament is hurting him and his party,” wrote:

His relationship with the world is primarily rational and analytical rather than intuitive or emotional. ... His tendency to focus on substance can make him seem remote and technocratic.

But Weisberg limited his analysis to Obama’s apparent failure to connect emotionally to the masses rather than his emotional incapacity to manage crisis. In short, when the center cannot hold, even Obama’s worst critics would agree that the last thing we want is a crazy person in the control room.

No! says Nassir Ghaemi most unambiguously. The last thing, in effect, we want is normal. According to Dr Ghaemi:

“No drama” Obama might be considered the epitome of mental health. We like our presidents moderate and middle-of-the-road - psychologically even more than politically. But psychological moderation is not what marks our great presidents. Can we applaud passion, embrace anxiety, accept irrationality, appreciate risk-taking, even prefer depression? When we have such presidents - the charismatic emotional ones, like Bill Clinton - we might have to accept some vices as the price of their psychological talents.

Dr Ghaemi is by no means the first in making a case for abnormal tendencies as leadership virtues. Joshua Shenk's 2005 "Lincoln’s Melancholy," for instance, brilliantly documents how Lincoln’s personal failures and his lifelong history of depression paradoxically molded him to take charge in the face of the greatest-ever challenge to the US.

As I noted in my mcmanweb review, Lincoln and His Depressions: “Lincoln’s melancholia allowed him to see events with preternatural second sight.” Dr Ghaemi refers to this as “depressive realism,” a gift shared by Churchill, Gandhi, Martin Luther King, and others.

But Dr Ghaemi tells us a little bit manic is also a good thing, exemplified by FDR and JFK. The base temperaments (hyperthymic) of these two Presidents may have been poles apart from the likes of Lincoln and the rest, but what all these great leaders shared in common were lives characterized by struggle and personal setback. Thus - born different, shaped different. And in crisis situations, different - not normal - is what we want.

Crazy, in effect, is normal to us. You know it, I know it.

Thus, of all things, when crunch time came - while the world around them was going bananas - the crazy ones - Lincoln, Churchill, JFK and the others - turned out to be the sane, level-headed ones.

They stayed calm, they listened, they identified with others. Moreover, they grasped what needed to be done, took charge, articulated their vision, rallied their troops. And they acted. If something went wrong, they owned the disaster, learned from their mistakes, made the necessary course corrections, and rose to the occasion - again and again and again.

Here’s where it really gets interesting. “Normal” individuals, says Dr Ghaemi, are singularly unsuited for crisis. Their brains were built for handling predictable situations in quieter times. When the unexpected occurs, they are typically at a loss. What seems to be happening, according to Dr Ghaemi, is their world view is totally out of sync with actual events. They don’t know what to do. They make fatal mistakes that they compound by rationalizing and justifying. Thus, in the case of Nixon with Watergate:

Faced with the greatest political crisis of his life, he handled it the way [a normal person] would handle it: he lied, and he dug in, and he fought.

In a similar fashion, George W Bush went weird on us. But here is the punch line: According to Dr Ghaemi, both Nixon and Bush were perfectly normal. Call Nixon delusional and paranoid. Call Bush stupid and irrational. But you’re wrong on all counts, according to Ghaemi. Until 1973, Nixon was the most successful person on earth. And all through his life, everyone wanted to be friends with George W.

But when faced with crisis, both Nixon and Bush essentially lost their bearings. Can you see the stigma issue here? Dr Ghaemi certainly can. We’re afraid to attribute success to crazy, but we are all too quick to assign it to failure.

But Nixon had to have been crazy. No, says Dr Ghaemi. What looks like crazy were normal individuals reacting to crisis in a normal way. A crazy person (or at least the right kind of crazy person), in effect, would have reacted in a way that came across as normal.

Confused? Throw away your conventional wisdom, says Dr Ghaemi. Normal isn’t always an asset. And there are clearly times when normal is neither the rational nor the best course.

So, perhaps now you can understand the title to this blog. Where we needed a Lincoln or a Churchill or a JFK, we elected someone with an even temperament. Crazy world we live in.


This is the opening to many more blog pieces based on Dr Ghaemi’s highly illuminating “A First Rate Madness.” I am looking forward to your comments and to a lively discussion. Stay tuned ...

Don't miss it

Dr Ghaemi will be featured tonight - Mon, Aug 8 - on The Colbert Report. 

Thursday, August 4, 2011

Rerun: Thinking of Going Off Your Meds? - You Need to Read This First

Going off meds may be a sensible and responsible personal decision for you - with the emphasis on sensible and responsible. Tragically, too many of us opt for crazy and irresponsible. Whatever choice you make, first you need to be reading my friend Judy's book, which I very strongly recommend for anyone living with a mood disorder, including loved ones. This review first appeared on my website in 2005, then I ran it here in Oct 2009. Definitely worth a re-rerun:

A sobering reminder of the heartbreak and hurt we can inflict on our partners comes through loud and clear in the poignant memoir by Judy Eron, "What Goes Up: Surviving the Manic Episode of a Loved One." Judy and her husband Jim, whom she had known for nine-and-a half years, were well on their way to realizing their dreams. They had uprooted from Tennessee to build their little hideaway in the desolately beautiful Big Bend region of Texas. There they planned to spend most of their time together in splendid isolation, but no sooner was their homestead ready for occupancy when Jim went off his lithium.

"It is a strange set of circumstances," Judy begins, "when a wife wakes up every morning wishing her husband would get severely depressed or arrested." Or has an automobile accident that sends him to the hospital or is caught running naked in the streets.

Anything that might take him out of his destructive mania.

By the time they reached Washington, their summer retreat from the Texas heat, Jim was already behaving strangely – first the pressured talking, then rudeness and impatience soon escalating into grandiosity, infidelity, dangerous behavior, and abuse. No one was going to tell Jim anything was wrong, least of all his wife.

Writes Judy: "If Jim had met another woman and fallen out of love with me, I could have coped somehow." Her life experience had at least prepared her for getting jilted by the proverbial blonde, but despite being a psychotherapist this was totally new. It was as if the mother ship had switched her loving and caring soul mate for an alien impostor somewhere out over the Texas desert. The eggshells she found herself walking on started to crack and she had no choice but to seek refuge in her friends and family.

Through an agonizing year she waited in vain for the crash that everyone said would happen or the 911 situation that would put him in the hospital. Or for Jim to come to his senses on his own. But the man she loved was far too in thrall to his "natural" self, even if that meant, ironically, trading his prescription drugs for recreational ones. Many a time Judy allowed herself to get her hopes up as the situation appeared it might resolve, only to end up bitterly disappointed. There was nothing she could do except take care of herself. Kay Jamison, herself, had told her exactly that. People in a state of mania, by definition, are out of control.

The book’s title implies that Jim must have come down. But we’ll never know that. He could have remained up. No one was around to see him crash. Judy assumes he must have, but mania has a way of turning on its victim, of creating an energized hell that leaves only one way out. One clear October day in the Texas desert – perhaps depressed, perhaps manic, most likely a combination of both - Jim took that only way out. It was an inevitability rather than a choice.

It was the Jewish Day of Atonement. At-one-ment. Jim had completed his tortured path to spiritual wholeness. For the woman he left behind, putting back the shattered pieces of her life was only just beginning.

Dealing With a Loved One’s Mania

Judy’s penultimate chapter is entitled "Woulda, Coulda, Shoulda." In a cruel twist of the knife, survivors inevitably end up blaming themselves for failing to respond with the impossibly precise measure of support, patience, compassion, confrontation, and tough love. As if they somehow foolishly left the eggs out of a recipe for baking a cake. In truth, Judy did everything she could have done, just like all survivors. There are no manuals, no guarantees.

Having said that, Judy does proffer some useful advice, based on her experience and research, principally:

  • You should not try to deal with mania by yourself. Forge a strong alliance with a psychiatrist and build a support network.
  • Know that you are dealing with someone out of control, who can no longer be trusted.
  • Be ready to take responsibility for being the decision-maker.
  • Look after yourself. Keep your life going.
  • Read as much as you can about the illness.
  • A manic person "will hammer on your weakest spots to bend you to his way of thinking, namely that he’s not sick."
  • "Without a doubt, you will be abused emotionally. You may decide to bail out … You are only human. Love is powerful, but in the face of mania, it is not all-powerful."
You can purchase What Goes Up at Amazon or go to her website.

Wednesday, August 3, 2011

Relationships: How Does Bipolar Figure Into It?

I’ve spent the last few days working on a talk I will be giving here in San Diego to the International Bipolar Foundation on Thursday, Sept 8. My talk will be on relationships, which I am an expert in, having been in and out of two marriages. Let’s pick up on the action, two-thirds into my rough draft ...

Okay, let’s throw bipolar into the equation. Same stressful situation. Who is the one likely to freak out? The so-called normal one or the one with bipolar?

How many think the one with bipolar?

Okay, stress looms large in bipolar. We have genetically vulnerable brains. We are hardwired to over-react to what goes on around us. In times of stress, our limbic systems are over-activated. Our prefrontal cortex tends to go off-line.

Also, our brains have difficulty filtering out the world around us. We get overwhelmed very quickly.

Can anyone make a case for the so-called normal one freaking out?

Keep in mind, crazy people don’t have a monopoly on freaking out. Freaking out is a perfectly normal response to stress. So, can you imagine situations where the normal person is the one freaking out and the person with bipolar is as cool as a cucumber?

I can imagine a bunch of them. Keep in mind, crazy is normal to us. We’re used to disasters and to facing challenges. When our world comes crashing down on us, it’s often no big deal. Paradoxically, we are often in far better shape to deal with the situation.

This isn’t just some wacky idea of mine. Nassir Ghaemi in his new book, A First-Rate Madness, contends that a life-time without being tested leaves one ill-prepared to handle crisis. The great leaders have never had that problem. Think - Lincoln, Churchill, Gandhi, Martin Luther King.

Also, a lot of us think and perceive differently. We connect dots in very unusual ways and come up with amazingly creative ways of looking at situations. Often, this means solutions present themselves in an instant - as events unfold - so there is no crisis to begin with. No reason to freak out for us.

But this ability to think and perceive differently also works the other way for us. We can sniff out bad stuff well before it happens. Contrary to what many may believe, we don’t simply get excited over nothing.   

Rather than look at people as normal vs crazy, I look at people as linear vs non-linear.

This is the way most people think most of the time:

This is the way a lot of people like me think a lot of the time:

So what’s four like? Depends. Everything may be okay. Or it could be a good reason to freak out.

What’s 28 like? Same thing. Depends. Could be okay. Perhaps reason to freak out.

So, here we are. Same situation. Two completely different brains.

We are never going to see eye to eye. You’re reacting to 4. I’m reacting to 28. How do you think that’s going to work?

So - third rule of relationships.

If you perceived the same stuff the other person did, you might be freaking out even worse.

Unfortunately for us non-linear people, the linear people are in the majority. We have to conform to their world. Their world is totally stupid and makes no sense to me, but there you go - I have no choice but to try to fit in.

As I like to joke: We're peanut butter people trying to fit into a tofu world governed by Vulcans.

International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

5:30-6:00- SOCIAL
6:45-7:00- Q & A
Sanford Children's Research Center, Building 12
10905 Road to Cure, San Diego 92121