A first-rate madness: uncovering the links between leadership and mental illness

most of us make a basic and reasonable assumption about sanity: we think it produces good results, and we believe insanity is a problem. 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.

Both men saw genius as biological in origin, but one believed it arose from illness, the other from health.

Four key elements of some mental illnesses—mania and depression—appear to promote crisis leadership: realism, resilience, empathy, and creativity.

One might call it the Inverse Law of Sanity: when times are good, when peace reigns, and the ship of state only needs to sail straight, mentally healthy people function well as our leaders. When our world is in tumult, mentally ill leaders function best.

Contrary to popular belief, the psychiatric concept of clinical depression is different from ordinary sadness. Depression adds to sadness a constellation of physical symptoms that produce a general slowing and deadening of bodily functions. A depressive person sleeps less, and the nighttime becomes a dreaded chore that one can never achieve properly. Or one never gets out of bed; better sleep, if one can, since one can’t do anything else. Interest in life and activities declines. Thinking itself is difficult; concentration is shot; it’s hard enough to focus on three consecutive thoughts, much less read an entire book. Energy is low; constant fatigue, inexplicable and unyielding, wears one down. Food loses its taste. Or to feel better, one might eat more, perhaps to stave off boredom. The body moves slowly, falling to the declining rhythm of one’s thoughts. Or one paces anxiously, unable to relax. One feels that everything is one’s own fault; guilty, remorseful thoughts recur over and over. For some depressives, suicide can seem like the only way out of this morass; about 10 percent take their own lives.

The most popular psychological theory about depression these days is the cognitive-behavioral model, which views depression as distorting our perception of reality, making our thoughts abnormally negative. This model, the basis for cognitive-behavioral therapy, is contradicted by another theory that has a growing amount of clinical evidence behind it: the depressive realism hypothesis. This theory argues that depressed people aren’t depressed because they distort reality; they’re depressed because they see reality more clearly than other people do.

“Depression is a terrifying experience,” said one of my patients, “knowing that somebody is going to kill you, and that person is you.” Suicidal thoughts occur in about half of clinical depressive episodes.

The depressed person is mired in the past; the manic person is obsessed with the future. Both destroy the present in the process.

Mania is like a galloping horse: you win the race if you can hang on, or you fall off and never even finish.

The core of mania is impulsivity with heightened energy.

Creativity may have to do less with solving problems than with finding the right problems to solve.

breast cancer patients saw the experience of serious illness and subsequent recovery as transformative; they didn’t just go back to being who they were. They became different, and two-thirds of them said they’d changed for the better. But this sense of well-being came at a price. Taylor dryly noted, “From many of their accounts there emerged a mildly disturbing disregard for the truth.” The women emerged with a greater sense of control over their disease or their recovery than was actually the case. The typical patient consistently overestimated her likely survival compared to the known statistics and her own medical status. Interviewing the oncologists and psychotherapists who cared for these patients, the researchers found that their unrealistically optimistic attitudes correlated with better psychological adjustment. That is, the psychologically healthier patients were the most unrealistic. Taylor had discovered “positive illusion”—the opposite of depressive realism, a kind of healthy illusion found not just in a trivial button-pushing test, but in life-threatening illness.

This research suggests an important conclusion: when the depressive episode is over (and, short of suicide, all depressive periods end, usually within a year after they start), the intense experience of emotional identification with others might leave a lasting mental legacy. Emotional empathy, produced by the severe depressive episode, may prepare the mind for a long-term habit of appreciating others’ points of view.

Taken together, this research suggests that resilience emerges from a combination of social support (good friends and family), hardship (bad luck), and certain personality traits (especially hyperthymia).