The media entrepreneur Ted Turner died this month at age 87. The obituaries barely mention, or completely ignore, that Turner was diagnosed with bipolar illness and treated with lithium. Michael Smerconish finally made that point on his CNN show, something almost all other obituaries ignored.
That’s what we don’t want to admit as a culture: that effective leaders often have manic-depressive illness. Instead we want to view all mental illnesses as bad, purely bad, nothing but bad — hence the stigma against them. We don’t admit that there are positive qualities to some mental illnesses, especially MDI. Mania produces creativity and resilience to stress; depression produces empathy and makes one more realistic. These are the traits of great crisis leaders, which makes them more effective than normally mentally healthy leaders, who are less creative, resilient, empathic, and realistic. I examine these ideas in detail in A First-Rate Madness.
About 15 years ago, when I published that book, I wanted to choose a business entrepreneur to show how the benefits of manic and depressive traits for leadership extended beyond politics into the business world. I chose Turner because he had been diagnosed and treated for bipolar illness.
Turner clearly had manic highs and depressive lows, well documented in his memoir Call Me Ted. His father was diagnosed with manic-depressive illness, psychiatrically hospitalized, and died by suicide. Turner reached middle age before seeing a psychiatrist in 1985 — Dr. Frank Pittman in Atlanta — who diagnosed him with bipolar illness and started him on lithium. The effect was remarkable. As Time magazine reported in 1992, Turner’s girlfriend J.J. Ebaugh described the transformation: before lithium, “it was pretty scary to be around the guy sometimes because you never knew what in the world was going to happen next.” With lithium, he “became very even tempered… lithium is a miracle.”
Remember the timeline: In the 1970s, unmedicated and undiagnosed, Turner rose as an entrepreneur — saving his father’s company, buying TV stations, sports teams, winning the America’s Cup, and most importantly, starting CNN. All major gambles that paid off. By 1985, he was a rising star, but his personal life was in shambles: divorce, sexual impulsivity, excessive spending. His children later talked about how he could never sit still for longer than 15 minutes, how every conversation was a monologue lasting hours, how he was repeatedly suicidal. He had periods of severe depression, before and after lithium, though less so while taking it.
He appears to have taken lithium from 1985 to around 1992, during which time he consolidated CNN into a powerhouse and began his massive philanthropy around the environment and the United Nations. But as with many people with bipolar illness, he grew to dislike the drug. People with bipolar illness often miss their manic symptoms when medication treats them away. Turner felt he had no problem and that lithium did nothing — while those around him thought it was a miracle.
Being wealthy, he found a doctor willing to go along with what he wanted. This is routine. As my mentor Frederick Goodwin used to say, VIPs get the worst care, because clinicians don’t give them standard treatment. Bipolar illness is even more complicated in these settings, since it is the nature of the illness for people to deny having it. About half of persons with manic episodes do not realize they have it, even when hospitalized with severe symptoms. This “lack of insight” is a cardinal feature of mania. A good clinician does not accept such denial.
The statistics around bipolar illness are sobering. Only 15% of patients are treated with lithium — the gold standard — which would be like only 15% of people with infections receiving penicillin. Meanwhile, antidepressants, proven completely ineffective and equal to placebo in bipolar illness, are given to about 50% of patients. Bipolar illness is misdiagnosed in at least 40% of cases; patients wait at least a decade before being correctly diagnosed and see 3.3 specialists on average. A recent study found that 77% of patients are initially misdiagnosed. It’s very easy to find a clinician to say you don’t have bipolar illness. That doesn’t mean you don’t.
Turner later developed Lewy Body dementia. He seemed at times to suggest this explained his past mood swings. No physician, however, would claim that Lewy Body dementia could cause manic or depressive episodes in childhood, adolescence, and middle age — dementia is a disease of older age, almost by definition. On the other hand, bipolar illness has been shown to increase the risk of dementia fourfold. Dementia would be explained, even expected, in someone with untreated bipolar illness. Interestingly, in that same research, lithium prevented dementia in people with bipolar illness. Had Turner remained on lithium, he likely would never have developed Lewy Body dementia.
The story of Ted Turner is both a victory and a tragedy. The victory is all that he achieved — far more than almost all others — and in his humanity, his good-heartedness, and his extraordinary philanthropy. Another business entrepreneur with similar high-energy manic traits became president right around when Turner descended into dementia. If Turner had remained healthy, he could have been a remarkable alternative. What a fascinating election that would have been. What a wonderful president he might have made.
Now, with Turner’s death, we might pause to honor this good and creative man — effective not despite his likely manic-depressive illness, but because of it. It was part of his illness to deny it and stop treating it. That was not only to his detriment but to ours, because it deprived the world of his continued leadership into his later years — which, in retrospect, we still needed.