What makes the great ones? Ask almost anyone anywhere, and you’ll get the same response: some form of personal exertion, “determination” or “perseverance” or “vision”. Ask almost anyone, and you’ll receive a response rooted in the individual’s uncompromising leadership–they’ll speak of the necessary qualities which brought him/her to helm in a time when he/she was most needed. Others might go so far as to say that this kind of leadership sits within us all, but is only activated when one realizes it, believes in oneself, and confidently makes the strides towards achievement. This mythology speaks for presidents as much as social activists or stadium rockers. It is the “I will” and not the “Can I?” that brings one beyond one’s constraints (see below).

Not so for Tufts psychiatrist Nassir Ghaemi, author of the new book, A First Rate Madness, whose Wall Street Journal piece we covered a few weeks ago, and was interviewed this weekend by NPR. Based on clinical histories and psychoanalytic archaeology, Ghaemi finds that many of the world’s most important and visionary political and social leaders struggled greatly with mental illness and, what’s more, that this mental illness contributed to leadership. Focusing primarily on depression and mania, Ghaemi asserts in the interview (listen to it here) that these maladies, that afflicted Lincoln, Churchill, Ghandi, King, Kennedy, and FDR, served as potent tools for leadership rather than limitations. Indeed, Ghaemi goes so far as to say that the adolescent suicide attempts of King and Ghandi were indicative of severe depression, within which lay the seeds of astounding empathy and realism.

Ghaemi here is not only subverting the DNA of the sources of leadership, but also the stigma that so easily finds itself attached to the mentally wayward. No doubt Ghaemi is making harsh distinctions between those who have forms of “mania” and those who are psychologically “well-adjusted,” such as President Obama. The interesting turn, though, is that he is strongly asserting that those who are psychically well-adjusted are viewed as the ones with limitations, because of their lack of what Ghaemi calls “drama.” Again, this is not to insensitively underplay the negative immensities of these conditions, or the deep suffering they cause, but instead to point to a provocative notion about power–that those who intimately know weakness are those most apt to lead in crisis.

Ghaemi explains that one of the reasons mentally healthy people might actually have a disadvantage when trying to navigate a crisis is that most of the time, the average person has what psychologists call a “mild positive illusion.”

“We think that we’re slightly more intelligent, slightly better looking, than we really are,” Ghaemi says. “We tend to overestimate our control over our environment. And that can be quite fine under normal circumstances. That may actually help us to get more done because of that confidence, but a political leader needs to be realistic rather than just optimistic for the sake of optimism.”

Ghaemi says his research revealed that both King and Mohandas Gandhi tried to kill themselves during adolescence, and that both suffered severe bouts of depression later in life.

“I went through the John F. Kennedy medical records in his archives — I believe I’m the first psychiatrist to do so,” Ghaemi says. “His behaviors have been well known — his hypersexuality, his high energy — what I do is to go into the medical records and show how those symptoms really are consistent with this temperament called hyperthymic temperament in psychiatry, which means mild manic symptoms all the time. And then I base these diagnoses not just on these symptoms, but family history, because these illnesses are genetic… In the case of Kennedy, I extensively describe his treatment with steroids, which worsened his manic symptoms. He was even treated with a neuroleptic, an anti-psychotic, when he was in the White House, for a period of depression,” Ghaemi says.

As those drugs made his hyperthamic symptoms worse, he was a less successful as a leader.

“I think that was the case in the first year or two of his administration. Then his doctors got it under control,” he says. “They basically forced him to stop using so many of those drugs … and this correlates with the last year of his administration, when a lot of his policies changed remarkably and he became that major civil rights advocate, that very resilient Cold War leader who we now look back on and value very much.”

“The hyperthalmic temperament has been shown in studies to be the kind of personality that is most helpful in being able to withstand traumatic experiences like sexual abuse, war and not developing post-traumatic stress disorder symptoms,” Ghaemi says. “And I think that’s what kept him alive and kept him going during the 1940s and 1950s, whereas most of us wouldn’t have even though about running for president. We would have just wanted to be alive when we faced all the severe illness that he had.”

Ghaemi wonders whether President Obama, whom he points out has described himself as “well adjusted,” might actually be “a little less normal than we’ve been led to believe.”

“It’s possible,” Ghaemi says, “if we understand from his memoirs, that he dealt with a lot of identity crises personally and racially, which may have influenced his moods, his anxiety, his personality and made him much more nuanced than the average person might be.”

If holding out hope that a president of the United States has at least a little bit of mental illness seems strange, Ghaemi says, he hopes his book helps to correct “a deep prejudice in our society.”

“Many of us just believe that mental illness is inherently bad and mental health is inherently good,” he says. “And the message from both the science and the history that I’m discussing here is that there’s some good and some bad to both mental illness and mental health. I think the idea of a ‘No Drama Obama,’ of this very average, stable, healthy person, is a reflection … of that stigma, of the idea that if there’s any mental abnormality, it must be harmful. And in fact, if he has a little bit of drama to him, it might be quite helpful.”