Doctor's Review: Medicine on the Move

January 20, 2022

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The mental state of world leaders

The US election spawns some alarming questions

As the Trump campaign gathers steam, so do Trump epithets. He’s been called everything from the Cheeto-Dusted Bloviator and Xenophobic Sweet Potato to the Orange Hairball of Death and Destruction, and, more darkly, Hair Hitler and The Furor. Comedians like Stephen Colbert and Rosie O’Donnell have a simpler name for him: job security.

The humour derived from Trump’s antics may serve as a protective reflex that absorbs the shock of the fear that he could actually become president. Others, including those inside the Republican party, ask if he suffers from a mental illness and even if evil can exist in otherwise healthy minds.


Many a psychiatrist, looking back on history, has attempted to blame the existence of evil on mental states by diagnosing the maladies of cruel dictators. Hitler, of course, is a favourite. As early as 1933, respected psychiatrists dedicated their lives’ work to what is known as “the psychopathography of Hitler,” diagnosing the dictator with such disparate conditions as schizophrenia, hysteria, borderline personality disorder, abnormal brain laterization, Asperger syndrome, and PTSD.

Dr Nassir Ghaemi, a professor of psychiatry at Harvard Medical School who holds degrees in history, philosophy and public health, has a different view of the role that mental illness can take in determining the behaviours of world leaders. His somewhat radical thesis, put forth in his book A First Rate Madness, proposes that in times of peace, mentally healthy leaders perform well — but in times of crisis, mental illness can actually be an asset for a leader.

Dr Ghaemi sees three mental abnormalities cropping up in a host of revered leaders:, hyperthymia, cyclothymia, and dysthymia; or their more severe forms; mania, bipolar, and severe depression. He charts the presence of mental illness in historical figures by looking at symptoms, genetics, treatment, and the course taken by the illness. Churchill, Abraham Lincoln, Mahatma Ghandi, and Martin Luther King Jr., he says, were depressed, General William T. Sherman, media mogel Ted Turner, John F. Kennedy, and Hitler all experienced varying degrees of mania or bipolar states.

Linking genius with madness is an idea that Aristotle speculated about 2,500 years ago. At the height of the nineteeth century Romantic era, Italian psychiatrist Cesare Lombroso went so far as to assert that genius and insanity were inseparable. For Dr Ghaemi, desperate times call for desperate leaders. He draws attention to four key elements of mental illnesses which can, he says, accentuate leadership during crises: realism, resilience, empathy and creativity. Depression, he suggests, brings out all four of these qualities, while creativity and resilience can be found in manic illness.


Winston Churchill referred to his severe bouts of depression as “the Black Dog.” He was also noted for his high energy and huge work output, which continued into his old age. His wartime chief of staff, General Hastings, described in Churchill the classic cyclothymic personality, saying, “He’s either on the crest of the wave or in a trough … when he isn’t fast asleep, he’s a volcano.” Dr Ghaemi argues that Churchill’s depressive episodes provided him with the realism he needed to determine the level of threat posed by Germany, and the emotional experience needed to overcome despair on a global level. His mania, on the other hand, gave him energy and strength to refuse to submit to tyranny. He wrote 43 books in 72 volumes, talked incessantly, and was always plotting and planning.

Abraham Lincoln also famously struggled with depression. In 1841, as a 32-year-old state legislator, he was intensively medicated by his physician, Dr Anson Henry. A friend commented on the future president’s mental state at the time, “The doctors say he is within an inch of being a perfect lunatic for life. He was perfectly crazy for some time, not able to attend to his business at all.” He was given mercury tablets, which he called “my blue pills,” and probably subjected to blood-letting. In 1841, he wrote, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth.”

The acute empathy conjured by Lincoln’s depression made it impossible for him to tolerate the lack of equality for African Americans, while a powerful sense of realism allowed him to see the complexity of the political issues at work in his country. Mahatma Ghandi, and Martin Luther King, who also struggled with depression through their lives, prevailed in the face of similar issues, perhaps also because of their high degrees of realism and empathy associated with depression.

John F. Kennedy had a hyperthymic personality that was first worsened and later improved by medication, Dr Ghaemi theorizes. JFK and his family kept his medical details secret, including the fact that he suffered from Addison’s disease, a condition in which the adrenal glands fail to produce enough hormones. The disease severely compromised his immune system, leading to chronic intestinal disturbances and terrible back pain. He was treated with four kinds of steroids daily, as well as intramuscular procaine, barbiturates and amphetamines at his own request. Halfway through his presidency, in 1962, doctors got a better hold on what had become steroid abuse. After adjustments to his drug use, his career, which had been fraught with challenges, took a turn for the better. A victorious conclusion to the Cuban Missile Crisis was followed by crucial advances in the Civil Rights Movement. He was what his physician Dr Herbst called “a spectacular psychochemical success.”

Adolf Hitler had clear manic and depressive episodes throughout his life. During young adulthood, dangerous fits of depression, during which he wandered aimlessly in the fields and forests around Linz, his hometown, alternated with euphoric moods characterized by hyperactivity, grandiosity, over-talkativeness, and decreased need for sleep. He was also plagued by obsessiveness and prone to outbursts of temper. Hitler himself refers to his depression in Mein Kampf, where he writes, “As the Goddess of Misery took me in her arms and so often threatened to break me, the Will to Resist grew, and in the end the Will triumphed.”

Where medications helped JFK, they had an opposite effect on Hitler. When Kennedy’s mental health floundered as a result of drug abuse, his doctors took the reins and corrected his treatment. Not so with Hitler, whose doctors were loathe to defy him. By 1937 methamphetamines were exacerbating the symptoms of Hitler’s bi-polar disorder. Three kinds of psychoactive drugs — opiates, barbiturates and amphetamines, which were all the more potent for being administered intravenously — tipped the scales on his mental health. On one occasion in December 1942, he shouted nonstop for three hours. Twice, in 1938 and 1942, several generals tried unsuccessfully to persuade prominent psychiatrists to commit Hitler to a mental asylum.

Hitler’s descent into illness, and its monstrous results, point to an important factor in whether mental illness will help or hinder in leadership: treatment. With the right treatment, mental illness can deepen a leader’s capacity for wisdom and energy. When treatment goes awry, things can go very, very wrong.


What do today’s doctors have to say about Donald Trump? According to Dr Harold N Bornstein, Trump’s family physician, Trump recently completed a medical examination that “showed only positive results,” a strange choice of words. The doctor, who addressed his letter “To Whom It May Concern,” should indeed have given cause for concern if all his patient’s medical tests were positive. But the doctor blithely concluded that Trump’s test results were “astonishingly excellent.”

Not everyone is so certain. Prominent psychologists seem to agree that Trump is a textbook case of narcissistic personality disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). “He’s so classic that I’m archiving video clips of him to use in workshops because there’s no better example of his characteristics,” says clinical psychologist George Simon, who conducts seminars on manipulative behavior. Devoid of empathy, suffering from persecutory delusions, governed by feelings of omnipotence and grandiosity, and requiring excessive adulation. Trump certainly fits the bill.

As with the other mental illnesses, a little narcissism can be a good thing. According to the DSM-5, “Many highly successful individuals display personality traits that might be considered narcissistic.” Pablo Picasso, Elvis Presley, Sharon Stone, and Warren Beatty pulled it off admirably. But, warns the manual, when narcissistic traits become inflexible and maladaptive, they veer towards “disorder,” and have a high rate of comorbidity with other mental disorders, depressive and bipolar disorders in particular. The final decision on Mr Trump is left to history to decide.

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