Thursday, September 15, 2011

A First Rate Madness

Sometimes in this business you are called upon to treat a madman, or a madwoman, someone seemingly psychotic, talking way over your head, out there, but still oriented times three (person, place, time).   You sense genius. You feel that this person is smarter than you are, or at least as smart.

You recognize, right away, undeniable talent and intellect. He is a song-writer, a one-hit wonder. She is an artist. He is a poet; she directs a television show. He is a computer programmer; she is a doctor. And you’re humble. You go home and think, why in the world see me?

But you know why.  The patient needs your particular genius, because his madness is getting in the way. Others are complaining, complaining so loudly, you can hear them and they're not in the room, not even in the building.  You suspect mental illness.

And it usually is.  Nassir Ghaemi, author of A First Rate Madness:  Uncovering the links between leadership and mental illness, is of the opinion that it isn't always so bad.  Indeed, some creative people have a hyperthymic temperament.  They rarely need therapy, not unless no one else will listen to them.  It is not a disorder.

A Wikipedia definition: 

Hyperthymic temperament or hyperthymia (from the Ancient Greek θυμός for "spiritedness") is characterized by a personality style or set of personality traits that include
  • increased energy and productivity
  • short sleep patterns
  • vividness, activity extroversion
  • self-assurance, self-confidence
  • strong will
  • extreme talkativeness
  • tendency to repeat oneself
  • risk-taking/sensation seeking
  • breaking social norms
  • very strong libido
  • love of attention
  • low threshold for boredom
  • generosity and tendency to overspend
  • emotion sensitivity
  • cheerfulness and joviality
  • unusual warmth
  • expansiveness
  • tirelessness
  • irrepressible, infectious quality
Put a nickle in and a hyperthymic personality will talk your head off.  Some of us prefer to call it hypomania, a step away from true mania, which keeps some people up all night for days at a time. We wonder how it lasts, that functional happiness, but it does for the blessed few. For most of us, what goes up, must come down.

FDR had it, hyperthymia, survivors of trauma and hardship sometimes get it. We see it most often in the descendants of people who once had bi-polar disorder. Teddy Roosevelt, a fifth cousin to FDR, apparently suffered from bi-polar disorder, and Isaac Roosevelt, FDR's grandfather, a trained physician, never practiced. People thought him odd. Take note of the importance of a genogram, that family tree, early in treatment.

Here's how Dr. Ghaemi, in his wonderful little book, describes FDR : (italics mine)
HE WAS HIGHLY SOCIABLE. On his Harvard alumni questionnaire, when asked his aversions, he replied, "None." He spent about a quarter of the working day on the telephone without means of an intermediary. He know how to get people to do what he needed, even if they did not agree with him about why. Once, when asked why he asked political opponents to serve in his administration, he commented, "You know, a man will do a lot of right things for the wrong reasons."

His longtime associate and secretary of labor Frances Perkins (also a social worker, read her biography) called him "incurably sociable," even needing to read books aloud to others rather than by himself. His close aide Robert Jackson, who served him as attorney general and later as a Supreme Court justice, viewed FDR's sociability as his strongest asset: "It was here that Roosevelt was irresistible and inimitable. He liked people, almost any people. He liked their company, liked to pick their minds and see what they were thinking, liked to know the details of their lives and problems."
I shudder. I know him.  A genetic heartbeat away from real mania, more functional, and more loveable than any American leader ever, some say.

Therapists are much more likely to see bi-polar disorder and uni-polar depression, than a hyperthymic personality. Before I had ever heard the word, I labeled the condition (hyperthymia) as uni-polar, the good kind, the opposite of true unipolar depressive disorder, the only unipolar disorder in the DSM IV-TR.

We often catch uni-polar depression or bi-polar disorder when people can't function, aren't meeting their potential.  Kids are coerced to coming to therapy for not getting homework done, or not getting it in on time, breaking curfew.  They will say, (italics mine):
I can’t do it, there is no doing it, not this; my brain isn’t there.  I can’t focus, can’t see why I even should focus on school.  I do other things (more compelling things).  Doing my assignments feels absurd, a waste of time.  Did I tell you about the new guy I met downtown?  Let me play something for you on my harmonica. Can I just show you something on YouTube? Get me out of school, would you please?  These people, my teachers, are making me crazy. Could you, doctor, please?
Or they are too depressed to say anything.

Therapy, a quest for sanity, is a parental request. The bi-polar child, like an adult with the same disorder, is either vegetative or unstoppable, more than occasionally unreasonable, and often brilliant. Mad, brilliant, neither one without the other, indistinguishable, certainly, to themselves.

We distinguish it quite well, of course. Most of us don't trust people when they're too high. And they're not all geniuses. John F. Kennedy, in Ghaemi's good leader group, didn't shine academically, and most don't believe him to have been a genius.  But he was certainly manic, as were many of his relatives, and he had bouts of depression and suicidality. Still, he empathized with the down-trodden, and used his position for positive societal change.

We tend to find more often, however, is that the afflicted bi-polar disorder have less peripheral vision, not more, only see what their brains command them to see.  Significant others, family and friends, are lost. No empathy, not in the episode.Greatness will be during remission, perhaps, hypomania.

Indeed the manic adults we know aren't generally Presidents, they are not the political leaders.  They are your every day Joes, Janes, and when they have authority, will think so fast that others find them impossible, and their demands time-intensive and unreasonable.  The boss doesn't come to therapy.  His employees do.

Less manic at the top of the company (or family), the work is more likely to get done, and get done well. Similarly, rock stars who finally quit drugs will admit their work is better, straight. Like imbibing too much too often, sliding too far up or down, going manic or catatonic, creativity suffers.

Yet a select few, according to Dr. Ghaemi, still achieve greatness, in large part because of their illness.  The irresoluteness of mania, the empathy following depression, big things get done.

They are the minority, but we see them.  Nassir Ghaemi's detractors will say that for most, a bi-polar disorder diagnosis is tantamount to selfishness and inaccessibility.  The empathetic moments are too few and far between.  And we really can't tell a manic brain, not even the brain of a hyperthymic individual, necessarily, to go someplace it doesn’t want to go.

Ordinary people do what is expected of them.  We meet expectations, take one for the team.  We go to work because we know that if we don’t, we won’t get paid, and the family needs the money. We put one foot in front of the other, even when we don't feel like it, and go.  We can make ourselves go.

That's because we're ordinary. You can’t make an extraordinary brain do something ordinary.

The ordinary don't make good leaders, however, according to Dr. Ghaemi's thesis.  The normal among us, homoclites, aspire to do well, be good, and be liked. We carry on quietly, seek simple comfort, do what is expected.

A president like George Bush, normal in every way, even in his alcoholism (described as progressive until dysfunctional, when he chose to quit) is destined to fail his people in a crisis.  President Bush responded to 9-11 like normal people respond to an attack. Attacked, President Bush attacked back. And he didn’t have the guts, he didn’t have feeling enough for the dead and the victims in that far away land, to get out.

People with mental illness, on the other hand, are more empathetic (when not in the throes of an episode). They can’t deny their feelings, the breadth and depth of sadness they feel for the hard of luck, the down and out, the poor. Gandhi, Martin Luther King, Abraham Lincoln, all suffered from severe affective disorders and subsequently, empathized. Their empathy moved them to greatness, to do great things for humanity.

Ghaemi's thesis: There is an association between having suffered mental illness and choosing to do the right thing, even becoming a great leader in crisis.

That’s what I tell those young people, having read his book, the ones who can’t do their homework, the ones who can’t make their brains go where everyone else's brains, those ordinary brains, have no problem going. Think, greatness.  First rate.


Post Script:

(1) A First Rate Madness is a first rate book. I don’t even want to lend mine out. Nassir Ghaemi is wonderful writer, and I’m sure a very empathetic psychiatrist. He reviews many leaders, even Hitler, and defines Hitler’s followers as homoclites, just following orders.

Reflecting on that, post 9-11, I suppose this explains the popularity of terrorism. Suicide bombers, terrorists, are normal; they are followers. Having swallowed a leader’s ideology, they do what normal people do. They fight for what they believe is the truth.

(2) Nassir writes more than your average psychologist, but not more than your average hyperthymic blogger. Check out his blogs, Mood Swings and Free Associations.

(3) To read other bloggers who reviewed A First Rate Madness, check out:
Justice Jennifer
A Library of My Own
Chunky Monkey
What Would the Founders Think?
Lit Endeavors
A Bookish Affair
The Left Coaster
Deep Muck Big Rake
Scheduled soon:
The Abraham Lincoln Blog
They Gave Us a Republic


Liz said...

What a fascinating article---thank you so much.

Leigh said...

Sounds like my experience in art school - a collection of so many interesting, brilliant people - with so many "issues." Now that I think of it, the people who were most productive and successful displayed a number of those hyperthymic qualities. My husband included!

Thanks Doc.

Anonymous said...

First off, what a fantastic and thorough review! Thanks for being on the tour - I certainly enjoyed reading your thoughts. And second, you make a very good point about terrorism ... I hadn't thought about it that way before.

Anonymous said...

Have not read the book, but based on your review, I'm wondering if there is any analysis of gender in the book. Seems like most of the folks with mental illness who gained positions of power and leadership were/are men. The qualities that make those men successful are often de-valued in women. Just wunnerin, doc.

Anna said...

Very, very interesting. A cursory look at current theories about Joseph Smith, Jr (founder of the Latter Day Saint movement) would turn up a lot that fits in here.

porcini66 said...

Love the connection between bipolar in past generations and hyperthymia. Kinda gives me hope that my two girls might get the more watered down version. HA!

Sigh....I joke, but this really did touch a nerve as I saw my least one in the list and my husband's family is riddled with bipolar, mine with alcoholism/depression. Genetics like that make ya think twice about whether we shoulda had kids, ya know? (honestly can't imagine them NOT being here, and they are wonderful, but feel like the deck is stacked against em somehow...)

Keeping my fingers crossed that they will be successful enough to be able to afford therapy when the time comes.

Parwathy Narayan said...

This is really great news to me 'cause I'm bipolar and a doctor. As a psychiatry resident, I saw a lot of genius work coming out of those mentally ill patients. I hope I have some genius in me too. Nice blog!

Health information blog said...

Hey that was very nice,, I would love to visit your blog very often,, Thanks for sharing such wonderful thing.


Anonymous said...

Wow, this was incredibly insightful. I am so glad I stumbled across this article. Literally everything you said concerning the Hyperthymic Temperament described me. I never knew this actually had a name.

I am 26 year-old male. The bullet points that you listed describe me on an everyday basis. I think these attributes most certainly can work in one's favor; however, for me, there are a few of the attributes that you have listed that can also serve to alienate others, which is terribly disheartening--I am talking about the extreme extroversion, talkativeness, and particularly the strong will. These three traits work synergistically to accomplish much good---BUT, more often than not, these traits can overwhelm the other person, because they cannot consistently handle the high energy impact. The strong-willed nature is also very overwhelming to many--and I hate this. For me, I have always seen it as being enthusiastic and passionate. I think the key, for me at least, is just learning to become more self-aware, especially around people who are susceptible to being hurt and "oppressed" by a high energy personality. When I was a junior in college, one of my close friends who happened to be a girl told me--albeit very kindly--that she could only handle so much of me because I drained her. After thinking about what she said, it brought me to the conclusion that gifts must be used carefully--because they so often function as a double-edged sword.

Anonymous said...

I really feel for you, anonymous. I'm a 27 year old male with what I believe to be hyperthymia. I would definitely agree with the self-awareness piece. I just honestly find it exhausting to monitor myself all of the time, and that makes me feel pretty hopeless. It's like self-control, but for someone with a hyperthymic temperament, this self-control may be really laboring. Specifically, I have to actively tell my mind to shut off when interacting with people so that I can engage in what they are saying. It's hard to shut off my extreme problem-solving tendencies to stay in the moment and feel that connection with others. Like you, I have heard the exact same feedback about social interactions from multiple people. As these traits are becoming more pronounced as I get older and less insecure, I'm trying to figure out how to channel my energy into something that utilizes these hyperthymic tendencies. I read about all of the success that can come, but I think a huge part of that is being able to channel the energy into the right goal. Figuring out the self-awareness to not drain people, how to channel the energy, and choosing the right goal are all concerns I have moving forward, because I feel that if someone with a hyperthymic temperament learned these things, then they may find success and fulfillment.