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National Alliance on Mental Illness
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NAMI Bookshelf August 2011

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Book Review: "A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness" by Nassir Ghaemi, M.D.

The Penguin Press (2011), $27.95 (hardcover)

By Bob Carolla, NAMI Director of Media Relations

One of the best books to document and discuss in detail the link between mental illness—specifically depression—and great leadership is Lincoln's Melancholy by Joshua Wolf Shenk. Dr. Ghaemi, the director of the Mood Disorders Program at Tufts University, now takes the discussion of mental illness and leaders further by including bipolar disorder and expanding the scope to several other historical and contemporary leaders, including Civil War general William Sherman, Winston Churchill and Ted Turner. Also included are Mahatma Gandhi and Martin Luther King, whose names are new to "famous people" lists that provide inspiration to many people who live with mental illness.

The book makes the case that four elements are essential to leadership in times of crisis: realism, empathy, creativity and resilience. Living with depression can enhance the first two traits and mania can enrich the third. Both can help instill resiliency. At the same time, some conditions such as psychosis can prove disastrous.

Leadership can be exercised for good or evil— independent from mental illness. In other words, free will and moral values remain part of the equation. The book includes a chilling discussion of Adolf Hitler, who presided as the leader of Germany during World War II and the Holocaust; Ghaemi makes a case that Hitler lived with untreated bipolar disorder which gave him charisma, resilience and political creativity in his rise to power. On the other hand, by the time the war began, he was being treated with barbiturates and amphetamines (including meth) for insomnia and fatigue, a combination that only worsened his mental illness. Essentially, his mind spun out of control—possibly into some form of psychosis. In that respect, impairment of his leadership abilities because of heavy drug use was a stroke of good fortune for civilization. “In his final two years, Hitler probably never experienced a day of normal mood,” Ghaemi writes. “His world was collapsing; his mind already had.”

The book also includes discussion of other leaders such as John F. Kennedy, Richard Nixon and George W. Bush, arguing that “homoclite” leaders who “want to be liked” can be dangerous in times of crisis. “Normal” mental health may actually be a drawback. This section, as well a chapter on stigma and politics, are not the books strongest but they raise issues that are worth thinking about carefully. Would our country ever elect a president who acknowledges living with bipolar disorder—and perhaps even campaigns on it as a qualification suited for the times? In some cases, personal experience with mental illness may be a strength, providing vision and a foundation for brilliant leadership, but the stigma surrounding mental illness still prevents a completely open discussion.


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Book Review: "The First Episode of Psychosis: A Guide for Patients and Their Families" by Michael T. Compton and Beth Broussard

Oxford University Press (2009), $15.95

By Brendan McLean, NAMI Communications Coordinator

Approaching and treating serious mental illness when it first begins to show itself is one of the most important steps that can be taken to help limit the future progression of the illness. With serious mental illness such as schizophrenia or bipolar disorder, psychosis is often the form that these mental illnesses take. Psychosis is a word used to describe a person’s mental state when he or she is out of touch with reality. People with psychosis have difficulty separating false, personal experiences from the world everyone else experiences.

In their book, "The First Episode of Psychosis: A Guide for Patients and Their Families," Michael Compton and Beth Broussard have put together one of the most informative handbooks on the topic. Compton and Broussard take you through from the beginning of not knowing what psychosis is to the most effective methods to treat and manage it.

As the authors state, the exact cause of psychosis is unknown. There are two main hypotheses, the neurodevelopmental hypothesis and the diathesis-stress model. Compton and Broussard do an impeccable job mapping out the theorized paths of the illness and how the illness most likely is actually a combination of the two.

Despite its detailed scientific nature at some points, the text itself is incredibly easy to read and split up into well-thought-out sections with highlights of the important points made in the chapter. Some of the included chapters surround topics such as the symptoms of early psychosis, the evaluation and identification of psychosis and medicines and psychosocial treatments. The last sections of the book are devoted to the importance issues of staying healthy, fighting the stigma and providing support to the caregivers who care deeply for the individuals living with mental illness.

"The First Episode of Psychosis" provides readers with not only a great wealth of information on identifying and recovering from psychosis but also hope for the families and loved ones affected by serious mental illness.


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Book Review: "Ben Behind His Voices: One Family’s Journey From the Chaos of Schizophrenia to Hope" by Randye Kaye

Rowman and Littlefield (2011), $26.95 (hardcover)

By Doug Bradley, NAMI HelpLine Information and Referral Associate

"Ben Behind His Voices" details the struggles, initial defeats, sadness, subsequent victories, and joys of a family coming to terms with a son’s schizophrenia. Unlike purely “first hand” or “family” accounts, this book presents the viewpoints of all involved in this captivating family drama.

The story centers on Ben, the author’s son, whose gradual onset of schizophrenia began during high school, continued after he dropped out, and worsened until he was properly diagnosed in his early twenties. Although Ben had, and still has, difficulty recognizing his illness, he was aware at times that something was not right. At one point in his teens, Ben’s mother found him staring at a photo of himself smiling with his. Realizing how isolated and unhappy he had become, he asked, “Mom, what is happening to me?”

Many readers will recognize the frustration of Ben’s mother as she tries to find a doctor who can not only accurately diagnose her son, but who can also work effectively with him. The slow deterioration in Ben’s habits, beliefs, and personality over several years without an abrupt psychotic break resulted in several misdiagnoses including attention deficit/hyperactivity disorder (ADHD), depression, obsessive compulsive disorder (OCD) and bipolar illness.

While siblings of individuals living with mental illness are often left out of accounts of mental illness this book portrays the close relationship between Ben and his younger sister, Ali. With the onset of the illness Ali “loses” the brother she has known and has to reconcile with the fact that she will reach many milestones in life before the older brother she has idolized.

Ben finally gets the proper diagnosis and effective treatment. Keeping him on his medicine, however, is sometimes and his non-adherence results in several hospitalizations. However, with the resolute support of his family, Ben has stayed out of the hospital for more than five years.

This book is a good “up-close” description of all the ways mental illness affects families. Also notable is the help Randye Kaye says she received from NAMI support groups and education programs. In fact, she dedicates the book in part to Joyce Burland, Ph.D., who created NAMI Family-to-Family. One person missing from the dedication, however, is the author herself; a mother who persevered through years of confusion, isolation, heartache, and bureaucracy to bring her son back to health.

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