A Look at ‘First-Rate Madness’: How Mental Illness May Enhance Crisis Leadership

A few years ago, a book emerged on bookshelves that had a curious and engaging thesis. It asked: What is the link between mental illness and great leadership? It remains an interesting question because, well, often times mental illness—particularly depression and anxiety—is perceived as something “bad.”

More than this, if anyone in an important leadership role, say, a congressman, CEO, or medical doctor revealed that he or she has struggled with a mental illness, that person may become the subject of suspicion. In short, admitting publically that a person in an important position may struggle with depression or anxiety—in contemporary American life—is akin to committing social suicide.

Yet examples of individuals to defy this stereotype abound.

In his book, “First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness,” Nassir Ghaemi, explores the many personalities throughout history who tend to buck this trend, including Abraham Lincoln, Martin Luther King, Jr., and JFK. According to Ghaemi, these individuals remain great crisis leaders because they have learned to overcome adversity in their own lives.

“Depression makes leaders more realistic and empathic, and mania makes them more creative and resilient,” Ghaemi writes. He also goes one to say: “[W]hen 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 the world is in tumult, mentally ill leaders function best.”

Ghaemi calls this the “Inverse Law of Sanity.” According to him, there are four elements of some mental illnesses that promote crisis leadership. They are:

• Realism

• Resilience

• Empathy

• Creativity

Perhaps most famously, individuals such as Lincoln appeared to struggle with depression, and that—as Ghaemi suggests—may have made him able to develop and apply the four key elements during the American Civil War in the 1860s.

There is, of course, some danger in “re-interpreting” the mental lives of historical figures, as it is not an exact science. That is perhaps why some have argued against this approach, especially when dealing with someone as famous as Lincoln. But Ghaemi deals with these criticisms convincingly.

“Retrospective psychiatric diagnosis is fraught with risk and is never definitive,” he writes. Ghaemi also distinguishes between the type of analysis he advocates, which is based on a cognitive-behavioral model and bases its conclusions on sturdy evidence such as historical records and self-reports and the pseudoscientific approach that ran rampant throughout the first part of the last century, which was based more on Freudian psychoanalysis and speculative evidence.

To conclude, Ghaemi’s approach to connecting mental illness remains an interesting idea. That Lincoln’s depression helped him gain leadership insight, which, perhaps, helped guide the Union to success during the civil war may seem like a stretch to some, but to others such as Ghaemi, depressive and manic episodes may do exactly just that. Finally, what also remains important is by calling attention to this issue, perhaps it may be the first step in de-stigmatizing mental illness in our public arena, because, after all, if Lincoln’s depression helped him become a better leader during the civil war, what problems may it help you solve?


Ghaemi, N. (2011). A First-Rate Madness: Uncovering the Links between Leadership and Mental Illness. Penguin, New York.

Brooke Lamberti

Brooke Lamberti is a content writer based out of Scranton, Pennsylvania. She received a Bachelor of Science in Psychology from Marywood University, and has prior career experience working in social work and domestic violence advocacy. She has a passion for writing and helping others.

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