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Psychiatrist Nassir Ghaemi explores the surprising, persistent correlation between mental illness and leadership

Depressive and melancholic by nature, William Tecumseh Sherman drifted miserably in peacetime. He attracted demerits like houseflies at West Point before venturing out to San Francisco, where he tried banking and failed on a large scale, accruing immense debts that forced him to take a string of menial jobs. In the 1850s, while in his early 40s, Sherman was reduced to moving in with his father-in-law. He had few real prospects. But within a decade, during the Civil War, this moody, disgruntled man rose to eminence, moving brilliantly and forcefully on the battlefield and stamping his name indelibly into the history books.

What in the world happened?

Nassir Ghaemi, a professor of psychiatry and head of the Mood Disorders Clinic at Tufts Medical Center, argues that nothing much happened at all. The same alternating dark and manic traits that Sherman had exhibited all his life, Ghaemi says, found an essential use amid the tumult of war. In his book A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness (Penguin), the author surveys historical figures, including Sherman, Lincoln, Churchill, Gandhi and Martin Luther King, among others, and finds each of them mentally unstable in a way that directly fed their achievements.

“We all suffer,” notes Nassir Ghaemi. “When you’re depressed, you become very aware that you suffer and everyone suffers.” Illustration: Betsy Hayes“We all suffer,” notes Nassir Ghaemi. “When you’re depressed, you become very aware that you suffer and everyone suffers.” Illustration: Betsy Hayes
Ghaemi, who, in addition to his medical training, earned an undergraduate degree in history at George Mason and a master’s in philosophy from Tufts in 2001, explains that he began with the high drama of the Civil War period, a personal favorite stomping ground (where “all the major leaders were mentally ill or abnormal in some way,” he says), and moved on to the 20th century. The psychiatrist’s quick rundown of select big names—Lincoln and Churchill brooded famously over personal and national losses; both Gandhi and King attempted suicide as adolescents—raises the inevitable question of how these men managed to thrive in extremely demanding public roles.

As Ghaemi puts it, “If they had all these symptoms, why did they function so well?”

The darkness brought its own rich light, he suggests. Manic behavior of the sort that Sherman demonstrated during his military campaigns has long been linked in the psychological literature with enhanced creativity. At the other end of the bipolar scale, depression tends to create wells of resilience and radical empathy in its carriers, as acute personal suffering is generalized outward to encompass the world.

“We all suffer,” notes Ghaemi. “When you’re depressed, you become very aware that you suffer and everyone suffers.” Here, he cites the sympathetically grieving examples of King and Gandhi.

Mental balance can be a handicap in troubled times, the psychiatrist contends, since the extreme challenges that leaders face, calling for comparably bold responses, may be altogether new and alien to their comprehension. He cites the British prime minister Neville Chamberlain (“who from all accounts was mentally healthy”) and recent U.S. president George W. Bush as evidence of even-keel temperaments that failed to meet the mark in their respective eras.

Ghaemi is smart enough to know he’s being provocative, and keeps his argument in a speculative, wondering tone. “Is all this just a huge sort of coincidence, or do the correlations imply causation?” he asks rhetorically. “That’s the recurring question in medicine. But there’s something going on here.”

Ultimately, Ghaemi says, he would like to see a basic cultural reappraisal of mental illness occur. Let’s strip away the stigma and deal with the ailment as matter-of-factly as a sore throat or a broken bone, he suggests. Mental illness is not all bad; as much as it is feared and misunderstood, the condition has its benefits. “Not so much for the person who suffers,” Ghaemi is quick to add to this latter point, “but for the society.”

This article first appeared in the Fall 2011 Tufts Medicine magazine.

Bruce Morgan can be reached at


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