No Hitler, no Holocaust, it is said. And yet Hitler did not create and maintain the Nazi regime all by himself. He was helped along by many other Nazi leaders who were, we now know, quite mentally healthy. They were homoclite leaders, devout followers of an ideology that they truly accepted. Banality does not do justice to this fact. Though they were disciples of the dictator, these Nazi leaders enjoyed great freedom of action for most of the Nazi regime. They were indispensable to Hitler, his eyes and ears and arms and hands. Without the second-rank Nazi leaders, no one man could have run such a totalitarian state. We must face the paradox: they were ghastly creatures, but they were mentally healthy, normal homoclites. It might seem that the term “homoclites” should not be used for such monsters, but only for nice, upright people like the students of Grinker’s YMCA college. But many Nazi leaders had also been nice, upright people most of their lives, before they became fanatic adherents of a racist doctrine. This disconcerting possibility may hold within it a dangerous wisdom about human psychology: the violence that lurks within even the healthiest of us.
And we can’t let the German people off this hook. Most historians would argue rightly that Hitler and the Nazis have to be understood within their wider social context. Here the homoclite masses of Germany become relevant. When the masses yearn for community and conformism, and respond to the charisma of a manic-depressive supreme leader, and are prodded along by second-rank homoclite leaders, in a world where other countries don’t respond to what is happening, and where poverty is rampant—one has an explosive mix.
We must not underestimate the dangers of homoclite psychology. It is not a matter of Hitler or the Nazi leaders or the German people just going bananas. The German people were mentally healthy, as were most of the Nazi leaders, and for most of his life Hitler’s bipolar disorder was helpful to his leadership and his charisma, despite its drawbacks. There is much more mental health here than illness. Germany and its Nazi leaders were not much different, psychologically, from any nation or any leaders. And that’s the scary part.
CHAPTER 15
STIGMA AND POLITICS
We are left with a dilemma. Mental health—sanity—does not ensure good leadership; in fact, it often entails the reverse. Mental illness can produce great leaders, but if the illness is too severe, or treated with the wrong drugs, it produces failure or, sometimes, evil. The relationship between mental illness and leadership turns out to be quite complex, but it certainly isn’t consistent with the common assumption that sanity is good, and insanity bad.
The thesis of this book runs counter to a deep cultural stigma accompanying mental illness. I suspect that it may be among our species’ deepest biases, more so than even racism or sexism. Even those who realize the problem of psychiatric stigma, like doctors, cannot escape their inherent stigma. Some studies show that physicians attach as much stigma to mental illness as the general population. Even mental health professionals, who attach the least stigma to mental illness, have negative attitudes toward some mental illnesses, especially schizophrenia and bipolar disorder. And even some mentally ill people themselves harbor stigmatizing beliefs about mental illness.
This stigma is the basis, I think, for most of the intuitively negative reactions that readers may have to this book’s theme. Those who have tried to argue otherwise have always noted this bias. Writing in latenineteenth-century Italy, the psychiatrist Cesare Lombroso noted that a “proud mediocrity” resists the notion that what is common, and thus normal, may not be best. In 1930s Germany, the psychiatrist Ernst Kretschmer observed the same stigma and called it out as a “prejudice” of psychiatric “inferiority”; it is “agreeable” to be sane, he noted, but “a sound mind is possessed by the man who is emotionally in a state of stable equilibrium and who has a general feeling of well-being. Peace of mind and restful emotions, however, have never been spurs to great deeds.” The same held in 1960s England when Lord Moran published his medical diaries about Churchill, revealing the great man’s depression. Churchill’s wife could not accept it (“It shows Winston in a completely false light”) and she tried to dissuade Moran from publishing it, citing doctor-patient confidentiality. America in the 1990s was no different. Just as the Churchill family blackballed Moran, the Kennedy family criticized Nigel Hamilton’s carefully documented evidence for John Kennedy’s youthful hyperthymia (even though Hamilton never claimed a psychiatric diagnosis).
Prejudice against mental illness crosses all societies and all historical epochs. Profound intuitive responses and beliefs have grown out of this stigma over millennia, and they will not change easily or soon.
However deep the stigma may be, the indisputable fact remains that the border between health and illness is porous. Some aspects of mental health are found in even the most severe mental illness, and some aspects of mental illness reside in the most mentally healthy person. In this regard, the Freudians were right; we all are mentally ill to some extent. Harvard psychologist Brendan Maher showed that abnormal, illogical thought processes are common in normal, mentally healthy people. They differ in degree but not in kind from the delusional thinking that characterizes schizophrenics. Researchers have identified a slew of irrational thinking habits—called mental heuristics and biases. These include treating familiar ideas less critically than unfamiliar ones, assuming a causal link between events that happen coincidentally, exaggerating the threat from uncommon risks, and many others. (One source identified thirty-one standard irrational thought processes.) The overlaps between normal sadness and clinical depression, and between normal happiness and mania, have also been much examined by professionals and laypeople. So whether we’re considering mood states or thought processes, the line between mental health and mental illness is hardly sharp, and the fuzziness at the borders means that some conditions will overlap each other. Mental illness isn’t like being pregnant—you are or you are not—it’s more like hypertension, or diabetes, or heart disease, all of which involve gradations of abnormality leading, in extreme cases, to specific events like a stroke, coma, or heart attacks.
Part of the stigma accompanying mental illness comes from our desire to view it as something completely “other”—utterly separate from those of us who are normal. But there is some of this “other” in all of us.
THESE CONSIDERATIONS obviously bear on contemporary politics and psychiatric practice. Regarding politics, recent experience in the United States suggests that stigma is alive and well. The last major national American politician to have admitted to any psychiatric condition was the unfortunate Missouri senator Thomas Eagleton, who was briefly the Democratic nominee for vice president in 1972. Soon after his nomination was announced, word spread that Eagleton had received electroconvulsive treatment (ECT) for depression, a common approach in that era (before most psychiatric drugs became widespread). We now know that he was hospitalized and treated three times between 1960 and 1966. Apparently he also received Thorazine, a medication now used for mania and psychosis (though also for depression in that era; it is similar to the Stelazine that Kennedy briefly received in the White House). Some have concluded that Eagleton may have had not just depression, but mania too, that is, bipolar disorder. After Democratic presidential candidate George McGovern dumped Eagleton from the ticket, despite Eagleton’s strong objections, the Missourian returned to the Senate for a long career (1968–1986), during which time he served with distinction and was never known to have been severely depressed or manic. After leaving the Senate, he went on to live another two decades, never once criticizing McGovern in public or seeking retrospective revenge on this critics.
Of course, we know what happened to the mentally healthy Richard Nixon, who beat McGovern by a landslide in 1972.
The Eagleton effect, as we might call it, has had long tendrils. The electorate can, it seems, accept mental illness in political spouses (with depression usually: Rosalynn Carter, Kitty Dukakis, Tipper Gore; sometimes with mania: the wife of Florida governor Jeb Bush); but no serious politic
ian has ever admitted even to being depressed. Abraham Lincoln couldn’t become president these days, nor could Winston Churchill become prime minister. Of course Lincoln and Churchill hid their severe depressions from their respective electorates. But will we, as a society, ever evolve to the point where we can seek out our Lincolns and Churchills instead of getting them despite ourselves?
We are not there yet. Even the recent election of Barack Obama suggests persistence of the stigma attached to mental illness. He was elected partly because he seems so calm, steady, and unemotional, particularly in contrast to the perceived volatility of John McCain. The candidate was aware of being normal, all too normal: “[Adviser David Axelrod] said to me he wasn’t so sure I’d be a good candidate because I was too normal. . . . Axelrod’s right. . . . I’m pretty well-adjusted.” “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 irritability, 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.
Atop the list of vices might be the one that most offends our Puritan heritage: sexual indiscretion. This vice is particularly applicable to this book’s thesis, since hypersexuality is a common symptom of mania—and a common trait among the leaders we’ve examined. The impeachment of Bill Clinton over his affair with Monica Lewinsky, a White House intern, brought forth years of pontification on sex and politics. The implication was, for Clinton critics, that a good president had to display “good character”—kindness, moral rectitude, self-control, and so on. “Character above all” became the mantra (the title, for instance, of a PBS broadcast subtitled An Exploration of Presidential Leadership). When George W. Bush ran for president, he implied as much when he echoed in his victory speech a note he struck often on the campaign trail: “And so, when I put my hand on the Bible, I will swear to not only uphold the laws of our land, I will swear to uphold the honor and dignity of the office to which I have been elected, so help me God.” Journalist Ronald Kessler titled his sympathetic biography of Bush A Matter of Character, and emphasized how Bush’s superior behavior made him a better leader than Clinton. Sexuality was always the underlying theme, but Kessler extended his claim to a more general lack of decorum, especially in how the president treated support staff, from cooks and maids to the Secret Service men Kessler interviewed. “With Bush, there was an instant change,” a former Secret Service agent told Kessler. “He was punctual. Clinton was never on time for anything. It was embarrassing. Bush and his wife treated you normally, decently. They had conversations with us. The Clintons were arrogant, standoffish, and paranoid. Everyone got a morale boost with Bush. He was the complete opposite of Clinton.”
I agree with the premise, but not the conclusion. Bush had more sexual continence than Clinton; he may have been better behaved with staff; he may have been more normal and decent. But all that might argue against, not for, better leadership skills as a president in time of crisis. Personal vices are, after all, much less of a problem than political shortcomings. As the bumper sticker popular during the Iraq war said, “Nobody died when Clinton lied.”
I am aware this viewpoint goes against conventional morality and the opinion of at least one founding father, John Adams, who famously said, “Public virtue cannot exist in a Nation without private Virtue.” But an excess of virtue is a vice, if we recall that the classical Greek concept of virtue, derived from Aristotle, involved moderation. Too much virtue converts courage to recklessness, for instance. It may be legitimate to turn around and flee, rather than fight, under the right circumstances. That’s what Aristotle meant by virtue, not some ideal of never-changing steadfastness. Given this perspective, one cannot cleanly separate virtue from vice, for the virtue of courage sometimes involves fighting, sometimes retreating, sometimes charging—each action interpretable as vices of violence, cowardice, and recklessness. Lincoln understood. “It’s my experience,” he once said, “that folks who have no vices have generally very few virtues.”
There is a link between this Puritan fusion of private virtue with political leadership and the problem of stigma accompanying mental illness: the insistence on making simplistic Manichean judgments about people’s behavior. One is a moral conflation, the other a psychological one. In this book, I am strongly suggesting that political skill on the one hand, and psychological health or even moral merit on the other, are unrelated in most cases, and in some instances may even be inversely related. A “normal” character is not inherently conducive to crisis leadership. In fact, once the benefits of mental illness are appreciated, then we have to accept that “abnormal” personal character traits may indicate better political leadership, irrespective of what our moral beliefs may tell us.
It’s not just about sex. As we’ve seen, the greatest leaders have committed an array of sins. Like alcoholism: Churchill definitely tended toward the extreme there. Or violence: Sherman was darkly savage in many ways. Like dishonesty: King and Kennedy were apparently not open with friends and family about their sexual affairs. Or coldness: Gandhi gave his family little attention or personal sympathy. Or arrogance: FDR had to endure polio before he achieved any measure of humility. Or recklessness: Ted Turner risked his fortune more than once. Some of these sins were unavoidable: hypersexuality and alcoholism, for instance, often arise in those with mood disorders. Other sins were intrinsic to the success of those who commited them. These weaknesses were also strengths.
Our leaders cannot be perfect; they need not be perfect; their imperfections indeed may produce their greatness. The indelible smudges on their character may be signs of brilliant leadership.
We make a mistake, however instinctive, when we choose leaders like us. This is our own arrogance, as normal homoclitic people. We overvalue ourselves; we think, being normal, that we are wonderful. We stigmatize those who differ from us, whether because of race, sex, habits, culture, religion—or, perhaps more viscerally, because of mental illness or abnormal behaviors.
I don’t mean to claim that it always takes a disturbed person to have a nuanced and humble view of life and the world. Many probably mentally healthy leaders are also complex and insightful: I would be inclined to include people like Harry Truman, Jimmy Carter and Nelson Mandela on such a list. My claim is that mental illnesses, like depression, do not detract from such abilities, but in fact can enhance them.
As we have seen throughout this book, the greatest leaders are often abnormal, even flat out mentally ill. We should accept, even celebrate, this possibility. Being normal is great in a friend and a spouse and in one’s daily life; but leaders of nations and armies and businesses are faced with tasks and crises that no one else faces in normal life. For abnormal challenges, abnormal leaders are needed.
We are far from accepting severe depression or mania in our leaders. But there is reason for hope. In 1990, Florida senator Lawton Chiles, running for governor, admitted to depression, which was successfully treated with Prozac. He was elected. Congressman Patrick Kennedy, the last political scion of that great clan, has been entirely open about his bipolar disorder and substance abuse, and he has made the stigma attached to mental illness the focus of his political career.
Stigma is not all or nothing: these days Prozac carries less stigma than ECT, and depression carries less stigma than in the past. But bipolar disorder remains highly stigmatized, and mania sounds scary to many. We have taken a few steps away from stigma, but many more remain to be taken.
THESE DAYS WE HAVE many more treatments for mental illnesses than we used to. Now we can not only improve but, perhaps more important (as seen with the cases of Hitler and Kennedy), worsen mental illnesses, raising some important questions about how the ideas in this book relate to treatment of conditions lik
e depression and mania.
To be clear, I believe that untreated depression and bipolar disorder can be dangerous and deadly. All patients should be treated, in my view, when their symptoms are severe. Many should be treated even when their symptoms are mild or moderate, or even when they have no symptoms, in the case of conditions like bipolar disorder, where the most effective treatment is prevention of future episodes with mood stabilizers like lithium.
We needn’t worry that drugs will deprive mentally ill leaders of the traits that make for great crisis leadership. Frankly, our drugs don’t work that well. Most people who take medications still have mood episodes and symptoms; it’s just that the medications can make them less frequent or less severe, thus preventing the suicide or psychosis that might otherwise result.
But sometimes, especially with mild depression, we should strive to see beyond the therapeutic imperative, and to realize that life is not all about banishing every symptom. The symptoms of depression might be an inescapable—and sometimes a beneficial—part of life.
This view contradicts the beliefs of many mental health professionals, especially those in the cognitive-behavioral therapy (CBT) school of thought. As I mentioned in the introduction, they believe that depression makes one more unrealistic than normal people. Many mental health professionals, especially psychiatrists, reject depressive realism in favor of CBT. But these perspectives are not necessarily contradictory. As with illusion—where the Goldilocks principle suggests that some is good and none or too much is bad—so it may be with depression. Some of it enhances realism, but none at all, or too much, may lead to distorted, illusory thinking.
A First-Rate Madness Page 26