Behind the Rhetoric

The rights and resources of people with mental illnesses have taken theirlong-overdue place in American politics. The Surgeon General's office issued its first Report on Mental Health (there have been 22 on smoking) and the White House hosted its first-ever conference on mental health, both under the guidance of the vice president's wife, Tipper Gore. At the state and national level, grassroots advocacy to increase funding and support--and decrease prejudice--for the mentally ill is gaining momentum. And as the presidential campaign evolves, voters now have every reason to expect the candidates to take these issues seriously.

At the same time, questions of mental health and character are being applied increasingly to our leaders. In this age of scripted, media-savvy campaigns, how can we decode the political language and political expressions of our candidates to make sure we're getting the leader we want? Political psychology can help. Here, PSYCHOLOGY TODAY presents the politics of mental health, and the mental health of politics (or politicians, anyway).

The Politics of Policy

In February, when the National Mental Health Association (NMHA) put out its report card on the presidential candidates' health plans, Vice President Albert Gore got an A-, while Governor George Bush received an F+.

It seemed that anyone voting on the basis of mental health policy had a clear choice. During his vice presidency, Al Gore and wife Tipper had become the gold standard for mental health advocates. The couple had emerged as leaders in the fight against mental illness stigma, and had promoted legislation that would increase resources and protection for the mentally ill.

In 1996, Tipper Gore came forward with the story of her own mother's serious depression (and periodic hospitalization) in her book Picture This: A Visual Diary. Three years later, she disclosed her own clinical depression, brought on when the couple's 6-year-old son was hit by a car. President Clinton appointed her Mental Health Policy Advisor, and she helped bring forth the first-ever Surgeon General's Report on Mental Illness. And in June 1999, she and the vice president created the first-ever White House conference on mental illness, where they were joined by the president and first lady in a day of discussions that culminated in the announcement that all federal employees would heretofore receive insurance coverage for mental illnesses on par with other illnesses. Whatever else might be said, the vice president had mental illness on his radar screen.

"Having Al Gore and Tipper, who are good parents and respectable people, talk about mental health issues has made my job so much easier," says Kim McPherson, policy advocate for the Mental Health Association in Bush's home state of Texas. The public relations benefits are immeasurable, she says, when the spokespeople could easily be the couple next door.

The NMHA's report card, however, is already outdated, and it turns out Governor Bush may deserve a higher mark. While mental health advocates in Texas who have worked with Bush don't call him a leader on these issues, they do credit him with some major shifts in state legislation, policy and funding that have benefited the disabled community,

"He definitely isn't in the forward movement, carrying the banner," comments Joe Lovelace, advocacy coordinator for the National Alliance for the Mentally Ill-Texas. "But he's also not an extreme right-winger who believes that mental illness is nothing more than a character flaw."

When George Bush was president, he signed a proclamation declaring the 1990s the "Decade of the Brain." What has his son done to promote that? In 1997, George W. signed the Texas parity law, becoming the first Republican governor to do so. In 1999, responding to state-funded research proving the efficacy of new-generation medications for severe mental illness, he recommended allocating tens of millions of state dollars. When the negotiating was done, $70 million in additional funding was added to provide new-generation medications and community support organizations for the poor.

Texas' Health and Human Services Commissioner Don Gilbert, a Bush appointee, also praises the governor for decentralizing supports for the mentally ill, a move aimed at handing over care to local organizations, which may know better than state offices what's needed in their regions. When Bush took office, Gilbert recounts, nearly half the counties in Texas had services provided directly by the state. By year's end, he told PSYCHOLOGY TODAY, all these supports will be offered by local organizations, supervised by the state.

On the other hand, advocates for the mentally ill say Governor Bush's actions have not been entirely to their liking. According to NAMI, even with the new appropriations, Texas ranks 43rd in the 50 states for per capita spending on mental health services; Texas State Representative Garnet Coleman has been frustrated by recent efforts to get more funding for people with bipolar disorder and schizophrenia; and in 1999, Bush authorized his attorney general to file a friend of the court brief in the Olmstead case in the Supreme Court that could chip away at protections for the disabled and the mentally ill in the Americans With Disabilities Act.

For this election, NMHA and NAMI, two major advocacy groups, have listed several issues as priorities: parity in insurance coverage for mental illnesses; financial and community support for the uninsured and those on Medicaid, particularly children; consumer protections and rights in managed care; access to mental health services and medications for the elderly; and reducing the stigma associated with mental illness.

How have the candidates responded? Gore has addressed most of these issues. In his May "New Family Agenda," he unveiled a plan to "help remove the stigma of mental illness," encourage insurance parity, support those caring for mentally ill family members, assist schools on mental health issues, and "provide access to full mental health coverage for all children--most of whom do not receive mental health services when they need them." "The availability of treatment of diabetes and the availability of treatment for depression or schizophrenia ought to be the same," he has said. "This is one that I will fix for you."

The wide-ranging, detailed plan addresses such issues as making sure parents in search of mental health help for their children do not lose their children to child welfare services in the process; supporting families of the mentally ill and others with the Family and Medical Leave Act (FMLA) and with tax credits; encouraging community- and home-based care over institutions; reaching out to the homeless; supporting scientific research into treatments for mental illness; and fighting for a "strong, enforceable patients' bill of rights."

In June, Bush delivered his "New Freedom Initiative," "to speed up the day when our country has removed the last barrier to full, independent, productive lives for every person, regardless of disability." His plan, while not specific, addressed his desire to see people with disabilities move toward independent living, as well as participation in the workforce and the community. He pledged his support for the Americans with Disabilities Act, which his father signed into law.

"In the Olmstead case last year," he said, "the Supreme Court ruled that, wherever possible, mentally ill persons are entitled to live in the 'most integrated' community settings rather than in institutions. This ruling, however, has not been completely carried out .... As president...I will sign an executive order committing my administration to its implementation." He did not, however, explain his participation in the challenge to Olmstead, which he filed with a friend of the court brief.

For advocacy efforts to succeed, it is key that the special needs of the mentally ill do not disappear behind the doors that have traditionally kept them hidden away.

"What we're really looking for [in the candidates]," comments NAMI's Michael Fitzpatrick, "is a public commitment to support this evidence-based and treatment-based system of care, and that it become part of their public program...to continue the public dialogue."

They're also concerned about whether the people around the furore president will let mental health advocates in the door. With Gore, there's little doubt: After all, one of this country's most vocal mental health advocates is his wife, who holds two degrees in psychology. With Bush, some questions remain. "I would be concerned with the people around him," says state representative Coleman. Coleman, who has bipolar disorder himself, authored the Texas mental health insurance parity bill, and has been a leader in the state's legislative efforts in these areas. "His staff has tended to be less interested than he would be personally," Coleman says. "If the people around him don't believe what he believes, how's it ever going to get to his desk?"

The Man Behind the Candidates

Personality Analysis

If the Clinton presidency achieved nothing else, it put personality back on the political radar screen--a reminder that the presidency involves a person as well as a role, and that, a la Nixon, a personality flaw, be it arrogance, ambition or poor impulse control, can bring down the office.

As we approach the presidential election, voters are surely asking themselves how to avoid another Monica-style scandal. Pollsters told us that Clinton was likeable and, lo and behold, we liked him. But what else should we have known about his personality before we pulled that lever? In this age of spin control and scripted media appearances, it's harder than ever to see the man behind the candidate.

"When you can put on images and fronts to appeal to whoever you need to appeal to, it leaves you with the question, 'Who is this person?'" says Anthony Pratkanis, a political psychologist at the University of California-Santa Cruz. "Is George Bush the right-winger of the primary or the centrist of the election?

It would be nice if we could seat Governor Bush and Vice President Gore in the psychologist's chair and subject them to a battery of scientifically validated tests-like those used to test leaders in the military and elsewhere--to study everything from personality to reasoning skills to leadership to creativity to managerial style to personal values. We'd be able to determine, with some degree of certainty, how they differ from each other, how they measure up to the population at large, and how they are likely to perform in the future.

Sadly, the presidential candidates are not lining up for their diagnostic testing, so PT turned to a host of political psychologists for their thoughts on the candidates. Without delving into armchair analysis, they reinforced the importance of personality, ethics, cognitive skill, communication, vision, emotional intelligence and other categories in determining if these men will make it to the White House and how they'll do if they get there.

Some, like Aubrey Immelman, Ph.D., of the International Society of Political Psychology and professor of psychology at Saint John's University, have created personality profiles of the candidates, matching their personality styles with syndromes in the psychologist's bible: The Diagnostic and Statistical Manual of Mental Disorders.

Immelman has found Bush to be "highly charismatic/extroverted and somewhat interpersonal/agreeable, but not very deliberative/conscientious." By contrast, Core looks "highly deliberative/conscientious, somewhat lacking in interpersonality/agreeableness, and low in charisma/extroversion." Not far, in fact, from the popular analysis: Bush-friendly but dumb; Gore-smart but stiff.

The idea here, as psychologist John Berecz, Ph.D., explains it, is that we can all be judged on the spectrum of personality disorders in the DSM. This doesn't mean we have a disorder, but our personality style can be used as a metaphor and a guide.

To Berecz, whose forthcoming book on the presidency, Character-in-Chief, describes nine personality styles in detail, Gore is basically an example of the obsessive-compulsive personality style. This is a benefit in the thinking-through of detailed programs, but it also can be a liability. "Obsessive-compulsives compartmentalize things," he explains. "I trust his personal morals--we're not going to have another intern in the back halls--but politically he might tell you with tears in his eyes about his sister dying of lung cancer [true story] and then tell the tobacco growers 'I'm with you.'"

Bush, according to Berecz's analysis, has more of a histrionic personality style, "emotionally alive, emotionally accessible." It's the trait that made Ronald Reagan so appealing to voters, but it doesn't indicate a sense of conviction or vision. "Some balance of the obsessive and histrionic is probably the ideal," said Berecz." If you had someone with the interpersonal skills of Reagan and the intellectual grasp of details of Carter, you'd probably have a pretty damn good president." Similarly, he adds, a hybrid John McCain/Bill Bradley would have done the trick.

Other researchers examine candidates using highly detailed analyses of verbal expression and facial gestures down to the smallest muscle, and correlating facial movement (the now-infamous Bush smirk) with personality [see sidebars, pages 50 and 52].

Still others look to history and leadership rather than psychology, studying, for instance, what we can learn from the ways a president ran meetings. Thomas Preston, assistant professor at Washington State University and author of the forthcoming The President and His Inner Circle, is developing a "leadership style typology." He is more interested in Gore's foreign policy experience during his vice presidency and Bush's lack of experience in that arena, and in the emotional ways each candidate responds to public crisis.

Robert Lefton, Ph.D., a psychologist and leadership consultant, studies leadership styles by focusing on how a leader makes decisions, relies on his staff, articulates his vision and executes his desires. Lefton rates leaders on two scales: dominance-submissiveness and warmth-hostility. Through studies of 20th-century White Houses, he has determined that the most successful presidents have a combination of warmth and dominance, listening to those around them but not being afraid to lead; and that the least successful are hostile and dominant (in a word, bullies). Bush, he believes, started out as hostile and submissive but is improving; and Gore to him is primarily a combination of warmth and submissiveness.

It's here, then, that the problems of these methods become clear. Is Gore warm and submissive, always aiming to please? Or is he "lacking in interpersonality/agreeableness," as Immelman suggests? Can psychologists who study leaders from afar accurately assess personality? Should they even try? And how do we know whether their own politics are not, intentionally or incidentally, jostling the evidence?

Perhaps we must simply adopt the perspective of Professor Fred Greenstein, author of the forthcoming The Presidential Difference: Leadership Style from Roosevelt to Clinton. "In a campaign, putting the candidates under pressure can reveal character," he reflected. But "the very best test of a person's abilities is the presidency itself."

READING BETWEEN THE LINES Speech analysis

Do you remember 1996 Republican candidate Bob Dole frequently proclaiming that he was the most optimistic man in America? And how many times did we hear Bill Clinton remind us that he was from a town called Hope?

These candidates have caught on to something political psychologists know: Optimism matters. Studies of letters and diaries of such leaders as Winston Churchill, Adolf Hitler, Josef Stalin, Franklin Roosevelt, former president Bush and Saddam Hussein have shown that the expression of optimism immediately before a military event foreshadowed increased aggression and risk-taking. In another line of research that inspired our contribution here, Harold Zullow, Ph.D., analyzed nomination acceptance speeches by Democratic and Republican presidential candidates and found, generally, that more optimistic candidates won the election 80% of the time, even when initial starting points in political polls were taken into account. Very simply, optimism conveys to the electorate that the candidate expects good things to happen and that he can make these things happen.

Our research on optimism looks at how people explain what happens to them, particularly setbacks. If the causal explanation entails factors that are long-lasting or stable ("it's going to last forever"), then they will have a chronic negative reaction to the events. If the cause is pervasive in its effects or global ("it's going to undermine everything"), then subsequent negative reactions will appear in a variety of areas. Finally, if the attributed cause is internal ("it's all my fault"), then the person's self-esteem will presumably drop following bad events. In contrast, optimistic explanations of bad events implicate circumscribed and external causes, and they make someone resilient in the wake or bad events.

The CAVE technique (Content Analysis of Verbatim Explanations) has proven useful in studies of individuals too elusive for conventional psychological study, including political and military leaders. To better understand the upcoming election, we have "CAVEd" causal expressions from Presidential candidates George W. Bush and Albert Gore. We worked with verbatim transcripts of speeches and interviews on talk shows, focusing on interviews conducted by seasoned interviewers like Larry King, Barbara Walters, Diane Sawyer and Jim Lehrer, all of whom have a reputation for getting past scripted answers. The dates of the interviews spanned a number of years, and in each case included some conducted before either individual was a candidate for president; they ranged from personal to international.

For each candidate, we had about 10 speeches or interviews, representing a total of more than 120,006 words. In these pages, we located bad events involving either Bush or Gore making causal explanations, identifiable by the use of phrases like "because," "due to," "as a result of," and so on. There were 72 event-explanation units for Bush and 70 for Gore which we each rated, independently, on 7-point scales according to its stability (e.g., "That's who I am") versus instability (e.g., "It was a partisan effort...by the Congress to remove him [President Clinton] from office"); globality (e.g., "A culture that seems to have undermined family and respect") versus specificity (e.g., "There's an editor...that writes for one OF those slick news magazines that's a Bill Clinton advisor"); and internality (e.g., "1 made mistakes") versus externality (e.g., "This is a military that's got very little morale"). The higher number corresponded with more optimism (unstable, specific and external).

We decided to rate some additional characteristics of the causal explanations. The explanations varied dramatically in terms OF vagueness, which we believe is significant because concrete explanations are verifiable and vague ones are not. Some causal explanations pointed to concrete causes (e.g., "the number of chlorine atoms in every part of the earth's atmosphere"), whereas others were diffuse (e.g., "evil remains").

We also rated each explanation in terms of its level of spin. For example, Gore explained his raising of campaign funds by telephone calls from his office by saying "my counsel tolls me there is no controlling legal authority that says there was any violations of the law." Bush explained his infamous smirk, saving, "I'm man who takes myself lightly at times." We don't know the full psychological significance of spin, but we do know that it's unattractive. In a recent study, we found that companies that spun bad events in their reports to stockholders had lower stock prices the following year. Presumably, the general public can detect spin and finds the phenomenon suspect.

For both vagueness and spin, we again used 7-point scales, where 7 signifies extreme vagueness and extreme spin, and 1 means concreteness and no spin.

A final characteristic we coded was the cognitive complexity of the cause: how many different perspectives are brought to bear in the account. We used a 5-point scale for this rating, where 1 means only a single perspective was introduced (e.g., "lousy journalism") and 3 means that several perspectives were used (e.g., "I liked the wry it [alcohol] tasted...it was an escape...I might have used it as a crutch"). A rating of 5, which we almost never assigned, means that the several perspectives were integrated into a coherent whole. Previous researchers have found that political leaders who score high in cognitive complexity are less likely to make impulsive and aggressive decisions and are more likely to compromise.

What did our ratings reveal? When compared to presidential candidates in the 20th century, neither Bush nor Gore stands out as especially optimistic or pessimistic. Gore was somewhat more optimistic than Bush, but this was largely due to his high scores on the externality dimension, i.e., he attributed bad events to sources other than himself. Zullow's findings indicate that Gore should be somewhat more appealing to the electorate than Bush. However, our own more resent research suggests that when leaders occasionally acknowledge responsibility for bad events, their followers are mope reassured than when responsibility is constantly eschewed. In terms of explanatory style and the impression it conveys, then, Bush looks better than Gore.

A closer look at our ratings shows that Gore was pessimistic when talking about the environment. In explaining problems with the physical well-being of the planet, Gore invoked stable and global causes, and he invariably included himself (as an inhabitant of the planet) as pat of the problem. If we remove these sorts of explanations (about 15% of the ones we coded for Gore) from the comparison, then Gore becomes notably more optimistic than Bush. Our advice to Gore? Stop talking about the environment--or start talking in more upbeat terms about the possibility of change--if you want to appeal to the public.

The other comparisons we made verified the popular stereotypes that Bush is not as deep a thinker as Gore. Explanations offered by Bush were more vague, more likely to be spun, and less cognitively complex. Of these characteristics, we know only that spin plays poorly. Vagueness appears unattractive, but it may bolster a candidate because it makes it difficult to ague that he is wrong. Cognitive complexity, despite its known consequences for leadership style, may or may not be attractive in a presidential candidate. Certainly, an overly complex candidate runs the risk of being dismissed as a wonk, and Gore is therefore treading on thin ice.

We're not going to predict a winner. But we will suggest that Gore may lose if he makes the environment a key campaign issue in the terms he has used in the past. We'll be following the campaign ahead with particular attention to how these differences play out. Will the candidates work at managing the impressions they make, or will they become even more characteristically themselves?

by Christopher Peterson, Ph.D., and Fiona Lee, Ph.D.

READING THEIR LIPS

Gore is stiff. Bush smirks. These are the platitudes of the 2000 presidential election. Political pundits and armchair psychologists have made whole chapters in their careers speculating on what we should make of Gore's Flat demeanor and that slightly crooked upturn of George W.'s mouth, which turns even his serious expressions awry.

What's really going on? Dacher Keltner, Ph.D., professor of psychology at the University of California-Berkeley, is part of a growing psychological field that can help us understand. This science of "reading faces" codes each muscle movement in the face, locates consistent facial gestures, and draws conclusions about what those patterns mean. Looking at a wide range of photos of Bush and Gore expressing everything from exuberance to serious thought, Keltner analyzed the candidates' characteristic expressions. If you want to see the difference between Gore and Bush, Keltner told PT, look in two places: the mouth and the eyebrows. (See chart at right.)

"One clearly sees character emerge in their expressive styles," Keltner told PT. "How will this affect their leadership? One might hypothesize that people (body politic, journalists, leaders of other countries) might trust Gore more but perhaps like Bush more. Reagan showed how powerful simply being liked can be." But that, he warns, would just be speculation.

--Sara Blustain

RELIABLE LINKAGES

Scientists like Keltner hesitate to tie these facial gestures to personality, but infer conservatively that they have been shown to relate consistently to states of mind. His conclusions are Fascinating: Gore expresses dominance, Bush, submissiveness. Gore shows concentration, Bush playfulness.

CHARACTERISTIC EXPRESSIONS

Below, Dacher Keltner, Ph.D., highlights the idiosyncratic aspects of the facial expressions typical of Al Gore and George Bush, accompanied by the industry-agreed-upon numerical codes (AU=action unit) for each expression, and the corresponding muscle name in parentheses.

In shorthand: first, Bush's eyebrows go up and Gore's go down. It doesn't matter if each is smiting or answering questions or resting neutrally. Second, Bush's mouth rests unevenly, while Gore's is often pursed. And third, in every photo studied, the gaze and head orientation of Gore are the same (if he looks up, his head orients up); Frequently for Bush, his gaze and head orientation disagree, suggesting he's communicating to multiple audiences, present or elsewhere.

Gore

1. The lip press (AU24; Oribicularis oris). Shows this when smiling and in neutral pose.

2. The eyebrow down (AU4; Corrugator supercilii, Depressor supercilii). Shows this in positive and negative expressions.

3. The lip purse (AU18; Incisivii labii superioris and Incisivil labii inferioris) and lip tighten (AU23; Obicularis oris) This accounts for the tightened pursed expression in Gore's mouth.

Bush

1. The asymmetrical smile (AU12; Zygomaticus major). Many of Bush's smiles have stronger muscle action on one side of the face.

2. The asymmetrical upper lip raise (AU10; Levator labii superioris) or asymmetrical lip corner tighten (AU14; Buccinator). These actions typically accompany Bush's smile, and account For the smirk.

3. The eyebrow raise (AU 1 + 2; Frentalis, pars medialis; Frontalis, pars lateralis). Bush frequently raises his eyebrows when smiling, which is somewhat unusual (in contrast, Gore often lowers eyebrows).

4. The smile and corner of mouth down (AU15; Depressor anguli otis). Although less frequent, it is interesting that Bush pulls his smile down.

5. Lip funnel (AU22; Orbicularis oris). Interesting because Bush often funnels his lips (almost like a purse) when smiling, which is something of a playful, flirtatious gesture.

Bush

Asymmetrical lip raise and lip corner tighten = mockery, contempt, disdain

Lip funnel = playfulness

Eyebrow raise = interest, submissiveness

Gore

Eyebrows down = concentration, focus on problem, dominance.

Lip press and lip purse = inhibition, constraint

PERSONALITY INRERENCES

Gore

Facial gestures reveal him to be more serious, constrained, controlled, weighty, ponderous, dominant.

Bush

His facial gestures convey that he is less serious, silly, at times contemptuous, though also open to others.

CHARACTERISTIC MIXED FACIAL MESSAGES, INDICATING MORE COMPLEX STATES

Gore

A combination of his pleasurable smile and either:

1. Eyebrow down (A4). Makes his smile look a bit pained or strained.

2. Lip press (AU24). Conveys that he is inhibiting his pleasure.

Bush

The conflict between his smile and asymmetrical lip raise and lip corner tighten (AU10, 14), connotes disdain and contempt alongside his warm smile.

AVERAGE CAUSAL EXPLANATIONS FOR BAD EVENTS BY BUSH (N = 72) AND GORE (N = 70)

Legend for Chart:

A - CHARACTERISTIC

B - RANGE

C - MEAN SCORE FOR BUSH

D - MEAN SCORE FOR GORE

A B C D

stability-instability 1-7 4.10 4.30

globality-specificity 1-7 4.01 4.22

[*]internality-externality 1-7 5.37 5.96

composite pessimism-optimism

(instability+specificity+externality) 1-7 4.49 4.82

[*]vagueness 1-7 4.07 3.44

[*]spin 1-7 3.21 2.23

[*]cognitive complexity 1-7 1.27 1.69

[*] different worth regarding as statistically meaningful

Why's his smile upside down?

PHOTO (COLOR): Eyebrows down show dominance.

PHOTO (COLOR): Eyebrows up show submissiveness.

PHOTO (COLOR): Do tight lips men tight-lipped?

PHOTO (COLOR): Is he presidential material?

PHOTO (COLOR): The Bush smirk.

Adapted by Ph.D. and Ph.D.

Sarah Blustain is associate editor of Lilith magazine and a journalist in New York

Christopher Peterson, Ph.D., is professor of psychology and director of clinical training at the University of Michigan

Fiona Lee, Ph.D., is assistant professor of psychology and assistant professor of organizational behavior and human resource management at the School of Business at the University of Michigan.