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2 INTERVIEW A little madness goes a long
way By
Victor Fic
You may be right / I may be
crazy / But I just may be the lunatic you're
looking for... - Billy Joel.
Dr
Nassir Ghamei is professor of psychiatry at Tufts
University School of Medicine and director of the
Mood Disorders Program at Tufts Medical Center in
Boston. Born in Tehran, Iran, he emigrated to the
United States at the age of five with his family
and was raised in Virginia by his father, a
neurosurgeon and neurologist.
Ghamei is
the author of A First-Rate Madness: Uncovering
the Links Between Leadership and Mental
Illness [1], which argues
that mental
characteristics often seen as mood disorders, such
as overt empathy, resilience or realism, can make
men or women perform as better leaders during a
crisis.
An expert in treating mental
illness, Ghamei warns that normality often does
not make not for an effective leader, while being
a little bit crazy can be a boon. The doctor tells
Victor Ficin an exclusive interview
that you might do more for world peace, akin to
the depressed Mahatma Gandhi and Martin Luther
King, if you are slightly nutty.
Victor Fic:Your fascinating
life journey starts in Iran, winds through
Virginia and now has you treating mental illness
... tell us about it.
Dr Nassir
Ghamei: I was born in Tehran but emigrated
to the US at age five with my family. My father, a
neurologist, was active in Iranian politics in the
1950s on behalf of the oil nationalization
movement and opted for political exile. My
education was in the public school system of my
home state of Virginia from kindergarten to my
medical degree. Then I moved to Boston, where I
have lived most of the last two decades. I
received specialized psychiatric training at
Harvard-affiliated hospitals such as McLean
Hospital and Massachusetts General Hospital, or
MGH. Later, I served full-time on the Harvard
faculty at MGH and Cambridge Hospital and am still
at the last place. I also worked for a few years
at Emory University in Atlanta before returning to
my current position at Tufts Medical Center in
Boston. I teach medical students and psychiatric
residents, treat patients with depression and
conduct research on bipolar disorder, especially
regarding treatment.
VF:
Your book demonstrates an excellent grasp of the
US Civil War, Adolf Hitler, the John F Kennedy era
and Mahatma Gandhi's career. How did you learn so
much history?
NG: I was also
educated in the humanities. My college bachelor's
degree was in history, with a dissertation on the
early 20th-century European socialist movement and
its reaction to the Russian revolution. Growing up
in Virginia, I was extensively exposed to Civil
War history in school and at battlefield sites,
and I studied these throughout my life. In my
research for my book, A First Rate Madness:
Uncovering the Links Between Leadership and Mental
Illness, I also benefited from close
collaboration with the prominent Civil War
historian Michael Fellman. I later obtained a
master's degree from Tufts in philosophy and a
Master of Public Health degree from Harvard. I
have written academic books on philosophy and
psychiatry too. [2]
VF: Did
you have any personal, inspiring encounters with
history?
NG: Living in
Boston, I also learned about the Kennedy era from
people who were part of it. I conducted extensive
original research in the Kennedy Presidential
Library. My father was active in Iranian politics
and a socialist admirer of [first prime minister
of India Jawaharla] Nehru, so I heard much about
Gandhi. I later lived in Atlanta, and studied Dr
Martin Luther King's career and met some of his
family and attended his home church services,
adding to my familiarity with his ideas. So A
First Rate Madness combined all my previous
education and life experience in psychiatry and
the humanities.
VF: What
caused your interest in mood disorders and how did
you realize these explain politico-historical
events and people?
NG: It
struck me as a condition psychiatrists could best
treat, unlike more severe illnesses like
schizophrenia. I realized that mood disorders were
relevant for great historical leaders because I
and other experts evaluate and treat politicians,
businessmen, doctors, lawyers and professors. Many
are successful, even with mood disorders. Yet we
cannot discuss them openly because of patient
confidentiality, augmented by the stigma against
these conditions. It leads such individuals to
hide their diagnoses. So I knew that if living
leaders have these conditions, we can examine the
public record of past leaders to demonstrate this
link.
VF: Do you hope that
if you can show how great men had mood disorders,
you can reduce the stigma?
NG: That is an important
motive. The stigma is a prejudice, like racism and
sexism, and similarly we must discuss why it is
wrong and change how our culture thinks about
mental illness.
VF: Explain
why you claim that some mental illness is
positive.
NG: Regarding the
benefits of mood disorders, the evidence varies.
The research on the benefits of depressive realism
in promoting empathy and realism is very strong
and replicated over three decades in many studies.
Next, creativity in mania is somewhat proven
especially in large studies on bipolar disorder
among writers. The issue of resilience is a
growing literature, with a few studies showing the
link to the hyperthymic temperament. This means
people such as president Franklin Roosevelt who
have high energy, sociability, retroversion, high
sexual drive and sense of humor, creativity,
charisma and talkativeness. The concept of the
hyperthymic temperament, though 70 years old, has
not been studied much until the past decade or so.
The link between depression and empathy is the
newest idea, and the number of studies here are
fewer than for the other leadership traits.
VF: Are you saying that
crazier is better among leaders and followers?
NG: The explanation focuses
on the four leadership traits enhanced by mood
disorders, namely depression enhances realism and
empathy and mania increases creativity and
resilience. Also, recall that Goldilocks rejected
some porridge as too hot and some as too cold. She
wanted it just right. I emphasize the Goldilocks
principle that one must have the right amount of
depression or mania for these benefits. Too much
or too little - in the latter case being
"completely normal" - are both harmful. I stress
that I am not saying that severe illness is
helpful, and I am not referring to any kind of
mental illness, like schizophrenia. I am limiting
my claim to mood illnesses.
VF: In connection, you
insist that - ironically - "normal" types that you
label "homoclites" are poor leaders ... why?
NG: They are adequate
leaders for stable times or mundane issues.
Studies show that manic or depressive people have
more realism, empathy, resilience, and creativity
compared to normal people who have not suffered
much and will be inspired leaders in crisis. So I
explicitly state that normal, mentally healthy
people have less of these qualities than those
with mood disorders. For instance, [former US]
president George W Bush and [former British prime
minister] Tony Blair are "normal" types who
reacted to 9/11 in predictable, conventional ways
rather than in creative and empathic ways - you
attack us, we'll attack you. I assert that
creative and empathic leaders like Gandhi or King
would have made other judgments, and, as I
document in relation to Cuba and Vietnam, leaders
like Kennedy were much less conventionally
reactive to external threats.
VF: But your analysis cuts
two ways because you could also say that their
opponents react in "normal' ways of retaliation
... .
NG: Certainly. Many,
if not most, world problems are caused by normal,
mentally healthy individuals fighting - with each
other. For instance, a poorly recognized fact is
that the Nazi leaders at the Nuremberg trials were
studied psychiatrically in much detail and deemed
mentally healthy in almost all cases. Thus, people
can be fanatic, even genocidal, and technically be
mentally "healthy", meaning they do not have
serious mental illnesses like schizophrenia,
bipolar disorder or severe recurrent depression
and they are within the normal variation of
personality traits. In fact, this is usually the
case. Of course, this does not justify the
Nuremberg Nazis' crimes. Many were executed
because they were responsible for their actions as
normal individuals.
VF:
Concerning John F Kennedy, you claim to make an
original diagnosis that his first drug regime
hobbled him but a latter mix fueled his success
... how do you know this?
NG: I did primary research
in his presidential archives as the first
psychiatrist to review all his medical records.
His underlying personality was hyperthymic,
meaning that he had mild manic symptoms as part of
his basic temperament all the time, not as part of
an illness with occasional mania. Research shows
hyperthymia is genetically and biologically
related to bipolar disorder as a mild variant. As
my book details, Kennedy abused intramuscular
anabolic steroids such as methyltestosterone given
as shots in muscles through much of 1961-1962. ...
VF: This adulterated or
skewed his thinking and actions?
NG: He was embroiled in the
Bay of Pigs [invasion] and his behavior was
erratic, indecisive, and sometimes aggressive. At
for the [1961] Vienna summit with [Soviet leader
Nikita] Khrushchev, he was indecisive and failed
to respond to Khrushchev's verbal threats and
taunting. His own secretary of state complained
privately, "Face it, we have no leadership in this
country."
VF: And you find
that Kennedy also waffled on domestic policy?
NG: Yes, on civil rights,
Kennedy feared that he could not lead because
congress was controlled by southern politicians,
and if he tried to force congress to support civil
rights he would lose the southern states for all
future Democratic candidates and his re-election.
VF: But you find that he
became the hero-leader on a better drug program?
NG: His doctors forced him
to stop the previous drugs and only gave him much
reduced oral doses of Halotestin to treat his
Addison's disease, which means lack of adrenalin.
In 1963, with his totally new regimen, he was much
more stable and clear-headed.
VF: Is it reflected in his
real world actions?
NG:This
change correlates strongly with his transition
from many political failures in 1961-62 to his
justly revered successes of late 1962-1963. During
the Cuban missile crisis, he was calm, decisive,
and resisted pressure from military and
intelligence officials for more war-like military
action. For the Berlin crisis, he showed great
confidence in standing up to Khrushchev's threats
and sending food and supplies to support West
Berliners, followed by his own famous speech
there. As for the civil rights bill and march on
Washington, he became a leader of the civil rights
movement. Kennedy sent a civil rights bill to
congress even though all his advisers except his
brother Robert recommended otherwise. He organized
the "March on Washington" and supported King's
group; he congratulated them immediately
afterwards in the White House. "You made this
happen," they told him. I assert that this
correlation is not coincidental.
VF: You argue that
psychotropics made Hitler far worse and that you
are the first to argue this...in what way?
NG: It has been
argued that Hitler was an "amphetamine addict" but
this is not the main issue. The real problem is
that he combined amphetamine use on a daily
intravenous basis - he received shots from 1937
onwards - with bipolar disorder. I clearly
diagnose that illness in Hitler, unlike most
previous writers. That is an explosive mix. The
interaction of bipolar disorder and long-term
intravenous amphetamine use is very dangerous. It
causes increasingly frequent and severe mania and
depression - and psychosis. No one has argued this
case before.
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NG: I was also
educated in the humanities. My college bachelor's
degree was in history, with a dissertation on the
early 20th-century European socialist movement and
its reaction to the Russian revolution. Growing up
in Virginia, I was extensively exposed to Civil
War history in school and at battlefield sites,
and I studied these throughout my life. In my
research for my book, A First Rate Madness:
Uncovering the Links Between Leadership and Mental
Illness, I also benefited from close
collaboration with the prominent Civil War
historian Michael Fellman. I later obtained a
master's degree from Tufts in philosophy and a
Master of Public Health degree from Harvard. I
have written academic books on philosophy and
psychiatry too. [2] 
