A First-Rate Madness (36 page)

Some people—especially among academics in the humanities and social sciences—doubt whether there is such a thing as mental illness. Some flatly deny its existence. Others allow for the reality of mental illness but argue that such illness is experienced in different ways in different eras, and thus any attempt to reconstruct mental illness anytime before our own era would simply involve transporting our own concepts into previous times. This would be the psychiatric equivalent of imposing our values when we assess why George Washington or Thomas Jefferson owned slaves.

The words academics use for this critique is “social construction.” Either mental illness is a complete social construction, a creation of human societies as a means of controlling those who deviate from the mainstream, or it is at least socially relative (the same illness is experienced and expressed differently over time and in different cultures). Both of these critiques have merit, but they don't constitute a reason to dismiss psychological history as invalid, just as they don't invalidate psychiatry as a practice. That social factors are relevant to mental illness (and thus to both psychiatry and psychological history) is nothing new; in fact, social factors are relevant to many illnesses. (Can we understand diabetes or hypertension without considering social factors?) The presence of social factors does not mean that illness is
nothing but
a social construction.

Rather, these critiques highlight the importance of paying attention to cultural and historical differences in the experience of illness, just as one does in contemporary psychiatry when assessing patients from different ethnic groups. Some illnesses vary so much by culture and by century that indeed they seem highly socially constructed; contemporary examples might include eating disorders and attention deficit disorder. Other conditions, however, seem reasonably stable over time and across cultures. Schizophrenia is found in almost all societies these days, and its current definition is based on similar descriptions from over a hundred years ago in Germany. Manic-depressive illness also seems stable across cultures, and has been described in the same manner for at least as long. The core constructs of these conditions, delusions in the case of schizophrenia and mania/melancholia in the case of manic-depressive illness, have been consistently described (the claims of some postmodernist historians notwithstanding) in human history dating back to ancient Greece and Rome. These conditions are not just socially constructed.

My conclusion is that psychological history should focus on these major mental illnesses—schizophrenia and manic-depressive illness (or bipolar disorder and recurrent severe depression, in current lingo). In these realms, historians and psychiatrists can share knowledge and interpret facts in a way that is both fertile and accurate.

 

 

NOW WE COME to what I expect will be the most common objection to the notion of psychological history.

Most of us have a universal belief: because I can explain why I feel or act a certain way, then those explanations must explain those feelings or actions. This especially holds for psychiatric labels: if I can explain why I am depressed or manic, then I am not ill with the diseases of depression or mania. Coming up with reasons makes everything “normal.” History can live without psychiatry, it might be argued, if reasons can be found that explain the actions of historical actors. But there are (wrong) reasons, and there are (right)
reasons
. There are always reasons; I imagine that if all books on history are examined, rare will be the place where a historian says, “We really don't know why X did Y.” So it is in life. Rare are the occasions where we admit about ourselves, or others, that we really don't know why we feel or act certain ways. More often, we come up with plausible guesses; then we mistake these for reality. The Jewish philosopher Maimonides once said that if one can only learn to say, “I don't know,” he will prosper.

In the daily work of psychiatry, it is typical to hear patients say, “Doctor, I'm not sick. I'm depressed because of X.” “I'm not bipolar. I acted that way because of Y.” It would be a poor psychiatrist who would accept the reasons of every patient at face value; in fact, no professional training in medicine or psychology would be needed if one took that approach. Indeed, neurological research on epilepsy patients who have surgery separating the two hemispheres of the brain (“split-brain” research) shows that people always come up with reasons for how they feel, even when the reasons are patently false. The most valid approach is neither to accept what patients say as truths nor to reject them as untruths, but rather to see everything as a half-truth, and to keep investigating until the whole picture comes together.

Historians routinely make this commonsense mistake of not accepting mental illness if a “cause” can be found. For instance, regarding General Sherman, historian Stephen Ambrose writes, “The manic-depressive goes into a mood for no reason at all; Sherman became exhilarated or depressed for excellent reasons.” Scientifically, this is simply a false statement. Mania and depression routinely are triggered (“caused,” if you like) by life events. And yet it is false to simply say, therefore, that the mania or depression does not happen, or that it can be reduced away to the life events. This has been proven by decades of excellent twin studies looking at genetic and environmental causes for depression in particular in thousands of persons.

One of my psychiatric colleagues, upon reading my chapter on Martin Luther King, still made this commonsense mistake, despite his psychiatric knowledge. King was not depressed because he “had” the illness of depression, this colleague remarked; he was depressed because of the extreme stress of living with the danger of death daily. This may be, or it could be that he had the disease of depression, or both.

This problem can't be easily dismissed: it is a profound dilemma that has exasperated philosophers for at least three centuries, since the philosopher David Hume starkly laid out this “problem of causation.” X happens; then Y happens; X happens; then Y happens; X happens; then Y happens. At some point, we conclude that X
causes
Y. But as Hume points out, this idea of “cause” only means the
constant conjunction
of X and Y. Someday, Y might not follow X, and our assumption of cause would be proven incorrect. But we cannot know whether this will happen or not. So in the meantime, we presume causation. In sum: saying something causes something else is always a probabilistic statement; one can never be 100 percent certain.

So it is with all knowledge: with philosophy, science, psychiatry, and history.

Historians have tended to dismiss any psychological studies of historical figures; they often suggest that psychiatric judgments are made too quickly, too easily. Yet these same historians implicitly make psychiatric judgments of normality as the default alternative, without providing strong grounds for doing so. The universal assumption of psychiatric normality seems to be worth questioning, and the careful assessment of psychiatric abnormality, within a wider context of mental health in most leaders, seems to be worth considering.

 

 

THERE IS ANOTHER important problem I need to acknowledge and address. It is not enough to say that some leaders may have had mental illnesses; they may have had carbuncles as well, and influenza, and hemorrhoids. What matters is showing how their mental illnesses affected their leadership skills, and whether these effects helped or hurt them as leaders. This kind of effort will inevitably be limited by the state of our knowledge regarding psychology and psychiatry (and of the biographical facts), but as long as we stick with accepted standards of science in interpreting psychology and psychiatry, this kind of psychological history will be as valid as any other interpretation of history. We should keep in mind that the historian, at least one who seeks to write narrative history, is always engaging in psychological history. The historian seeks to understand why leaders did what they did; he does so by trying to determine the mindset of that person in his context—his family, culture, society. The historian, in a way, puts himself in the place of the historical actor and empathizes, or understands from within. In that sense, psychological history already happens all the time. But because some historical figures were mentally ill, this empathic procedure doesn't always work. We cannot simply understand such a figure as if he or she were sane and rational, like us (presumably). Here is where some knowledge of psychiatry is not only helpful, but necessary. Here is where the old psychohistory ends and a new psychological history needs to begin.

There will always be an element of uncertainty, nonetheless, to any inferences one might make about the direct relation between a psychopathological state and a leadership skill. For instance, when I related Churchill's depression to his realistic assessment of Nazism, this inference cannot be directly proven. We wouldn't even be able to prove such an inference definitively had Churchill himself said, somewhere, something like, “I think I understand Hitler's true nature better than the rest of you because I have had severe depression and in those periods I have gained important insights into the world, especially into people like him.”

This problem also has a long and profound history. Philosophers have agonized over this matter almost as long as they have lost sleep over Hume and causation. Once we accept a probabilistic notion of “cause” like Hume's, we are then faced with the conundrum of whether such notions of cause apply the same way to all fields of knowledge. Is it the same thing to speak of “cause” when Newton's apple falls to the ground, or when Einstein's atoms collide, as when we speak of what caused Napoleon to invade Russia? Is “cause” the same thing in physics and history, in chemistry and psychology? Is it the same, in short, when we study nature versus when we study human beings who love, and hate, and believe, and doubt? The German philosopher Wilhelm Dilthey spent his entire life asking, and trying to answer, this question. And his answers, though profound, are still not widely accepted, or even understood.

This is not a simple question whose answer we can base on our commonsense beliefs. Dilthey suggests one solution: what we mean by “cause” is different in history and psychology than it is in biology and physics. There is overlap; the scientific concept of cause—involving counting, statistics, controls, and so on—can certainly be applied to human psychology. And we have used that kind of research throughout this book. But such scientific standards do not fully explain human history or psychology. People seem to draw meanings out of their experiences, and these meanings affect their actions. In history and psychology, we not only have to “explain” the facts; we have to “understand” the meanings of what people feel and what they do. We need to know not just “how” but “why.”

 

 

HISTORY ISN'T molecular biology. History involves the interpretation of people's motives and intentions. Psychiatry also entails interpreting people's motives and intentions. The only difference between history and psychiatry, in this sense, is mortality—psychiatrists examine the living, historians the dead, but both in the same manner. The average historian seeks to interpret motives based on common sense and rational judgment and empathic intuition. All this is defensible, as long as a logical and persuasive rationale is provided. Yet the same defensibility holds for the psychological historian who seeks to interpret motives based on psychopathology and psychiatric research, again as long as a logical and persuasive rationale is provided. Kretschmer noted in 1931 that we ignore the positive aspects of mental illnesses for historical figures, although we see them around us on a daily basis: “Whilst thus many men of genius themselves prize madness and insanity as the highest distinction of the exceptional man—the biographer stands with uplifted hands before him and guards him from desecration by the psychiatrist!” There is no inherent reason why legitimate psychiatric concepts should be banished from history, as has mostly been the case until now.

At bottom, the new approach to psychological history comes up against that deep human bias: the stigma of mental illness. In taking this approach, our stigmatizing intuitions continually will rise against us, just as racist and sexist intuitions bedeviled past historians. Psychological history can have this benefit too: it can begin the process of leading us, as a society, toward a more objective and fair understanding of mental illness, no longer as just darkness and doom—something purely negative, to be feared and avoided, or “socially constructed” away—but, without denying its harms and dangers, also as the source of some of the best qualities in humankind.

Over a decade ago, Michael Fellman's biography of General Sherman launched me on this project. Years later, after I published, with the editorial help of Paige Williams, an article on Sherman in
Atlanta
magazine, Michael became a central guide, adviser, and friend. I also benefited greatly from the friendship of Joshua Shenk, whose work on Lincoln catalyzed my thinking. Drew Westen generously introduced me to his agent, Susan Arellano, who provided critical hands-on help with my book proposal. Authors typically thank their editors profusely; I now understand why. Eamon Dolan not only gave me the opportunity to publish, but he sensitively guided both the content and style of the manuscript; I learned much in the process.

Others were kind in responding to queries on specific chapters, reading chapter drafts, or sharing ideas: Lauren Alloy, Ross Baldessarini, Carl Bell, Ed Diener, Frederick Goodwin, Stephen Kinzer, Martin Kitchen, Howard Kushner, Ed Mendelowitz, Godehard Oepen, Rick Perlstein, Ronald Pies, Alvin Poussaint, Dean Keith Simonton, Shelley Taylor, Tom Wootten, and my mother-in-law, Suzanne Hewitt. I especially thank Lord David Owen, whose ideas, encouragement, and example were vital. Elizabeth Whitham and Niki Holtzman assisted with sources, as did Sairah Thommi, who also helped with the endnotes and bibliography. Sergio Barroilhet assisted with research in the John F. Kennedy Presidential Library archives, whose efficient and professional staff I also acknowledge. Of friends who supportively followed the progress of this project, one is missing: James Hegarty, MD. Jim walked the streets of Gettysburg with me while we talked about these ideas, and he lived out Churchill's creed of never giving up.