Free A First-Rate Madness by Nassir Ghaemi Page A

realistic about the world, and thus better able to change it. Lincoln suffered immensely; Churchill suffered much; so did Sherman. Others who were luckier in their early lives—including, as we’ll see later in the book, McClellan and Neville Chamberlain—failed where the mentally ill leaders succeeded.
    Of course, everyone suffers. But life’s pain can come harshly or gently, earlier or later. For the lucky, suffering is less frequent, less severe, and delayed until it can’t be avoided. The unlucky, who, early in their lives, endure hardships and tragedies—or the challenge of mental illness—seem to become, not infrequently, our greatest leaders.

CHAPTER 4
    OUT OF THE WILDERNESS
    CHURCHILL
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    We remember Winston Churchill the orator, the fiery leader, the man who refused to submit to tyranny, and in whose stubborn refusal a nation, and then the world, found the strength to resist and ultimately prevail. Other prominent British statesmen had failed to fill the role that Churchill rode to glory. Churchill alone emerged as the great leader, the wartime genius, the deliverer of democracy. And although some acknowledge that he had mental problems, few appreciate the relevance of those problems to his prodigious leadership abilities. I believe that Churchill’s severe recurrent depressive episodes heightened his ability to realistically assess the threat that Germany posed.
    One might suppose that such a great man would have to be especially whole, healthy and fit in mind and body, full of mental and spiritual capabilities that escape average men. But Churchill belied this notion. In fact, he was quite ill, and his story, if belonging to a middle-class American living in the twenty-first century, would seem a sad but typical tale of mental illness.

    AS WE’VE SEEN, mental illnesses are partly genetic, and rare is the person with a severe illness who doesn’t have some evidence of the same in her family. In Churchill’s case, we don’t have to search far: his father died insane. Lord Randolph Churchill, the eighth Duke of Marlborough, had attained political prominence quickly, as his son would later, becoming chancellor of the Exchequer by his thirties. In normal circumstances, he would have been marked for the premiership, but Lord Randolph had character flaws that would disqualify him. One of these was a special fondness for sex; he had many dalliances throughout his life, and his will provided £20,000 to a Lady Colin Campbell, known as the “sex goddess” of Victorian England.
    Lord Randolph probably developed neurosyphilis (called “General Paralysis of the Insane”), which can cause manic and psychotic symptoms. In the nineteenth century, such cases were indistinguishable from schizophrenia, as defined by modern medicine. (Penicillin was used from the 1940s onward to cure neurosyphilis, hence it could be considered the most effective drug ever used for psychiatric symptoms.) Until the later development of laboratory tests for the bacterium that causes neurosyphilis, it was impossible to determine which patient had psychosis caused by syphilis and which had schizophrenia.
    It complicates matters that manic-depressive illness, which also causes psychosis, and was often mistaken for schizophrenia in the past, can make patients sexually impulsive and overactive during manic episodes, often engaging in prostitution, unsafe sex, or other indiscretions. Sexually transmitted diseases (like neurosyphilis) are thus more common in people with manic-depressive illness than in the general population. Cause and effect are difficult to disentangle. Was Lord Randolph insane because he had neurosyphilis, or was he insane because he was manic-depressive, or both?
    Neurosyphilis isn’t genetic. Yet we’ll see that Lord Randolph’s son Winston had a different mental illness, as did Winston’s daughter Diana, who had a major depressive episode in