Extreme Virtue presents a new and radical approach to the problems of leadership and virtue in public life. Originating in the author's newspaper writing about the Clinton/Lewinsky scandal, the book grapples with what has gone wrong in the American political system and describes what we should look for in our leaders. Sartwell argues that the real problem is a pervasive lack of truth in political leaders and that more can be accomplished by straight talk than by polling and focus groups.

The book consists of biographical portraits of five great Americans: anarchists Emma Goldman and Voltairine de Cleyre, conservative senator Barry Goldwater, Lakota spiritual leader John Fire Lame Deer, and black nationalist Malcolm X. The author argues that what makes these figures distinctively American is that each shares a suspicion of power and a vision of individual liberation. Despite their distinctive and unique approaches, each person is a model of truth in public life.