The Presidency: Temperament is the Real Issue

Patient Expert

I'm not the type to engage in election analysis, either post hoc, pre hoc, or just plain hoc. But ultimately, the race came down to an issue simply too important for us to ignore: Temperament.

Not the economy. Not Iraq. Not health care. Not race.

Virtually every babbling head has weighed in on the topic. Joe Klein, writing of Obama in Time magazine as the economy reached meltdown last month, is fairly representative: "His preternatural calm has proved reassuring ... "

No one is about to accuse me of an even temperament, and I'm sure this characterization has never been applied to you, either. Flying off the handle is a cardinal feature of our illness. Maintaining some level of control, on the other hand, poses a never-ending challenge. For insight, it is instructive to look at another recent President:

My friend John Gartner PhD last month published "In Search of Bill Clinton: A Psychological Biography." Dr Gartner, who teaches at John's Hopkins, is the author of one of my favorite books, "The Hypomanic Edge," which documents how a little bit of craziness has been extremely beneficial for America.

In Clinton, Dr Gartner found his hypomanic poster boy. People used to laugh when I first   raised the same (but far less sophisticated) argument six years ago. But the man's overly-publicized life speaks for itself. The former President is "up" all the time, literally, in every sense of the word.

Dr Gartner is quick to point out that he doesn't view Clinton as having bipolar or some weird strain of the illness. Instead, Dr Gartner views the former President as having a "hypomanic temperament." This correlates approximately to what Hagop Akiskal MD of UCSD describes a "hyperthymic" personality, Ronald Fieve MD of Columbia University as "beneficial hypomania," and Kay Jamison PhD of Johns Hopkins as "exuberance."

In this sense, for many of us, hypomania may a "trait," part of our true self, as opposed to a "state," where we act completely (and destructively) out of character. Psychiatry generally fails to appreciate this important distinction.

Think of just some of the praise-worthy terms used to describe Clinton: Charismatic, highly energetic, larger-than-life, charming, empathic, warm, feeling, sexy, inspirational, supremely intelligent, bursting with ideas.

Think also of some other attributes that fairly describe his character: Impulsive, prone to anger, undisciplined, unfocused, indulgent, grandiose, can't keep it in his pants.

Clearly, hypomania worked for Clinton, and he has the resume to prove it. As James Carville, who masterminded Clinton's 1992 campaign, likes to tell Republicans: "What didn't you like about the Clinton years, the peace or the prosperity?"

But Clinton's hypomanic temperament also proved his near-undoing, not to mention what it did to all those millions who placed their trust in him. Clearly, even beneficial hypomania is a double-edged sword.

Fast forward to 2008, with the world on the brink of economic catastrophe, and two contenders making their case to the American public. Clearly, John McCain had the upper hand, despite being yoked to a sitting President universally regarded as a disaster. He brought to the table character in abundance, together with experience and moral fortitude, not to mention his immanent likability.

But something funny happened. For the duration of the campaign, the real McCain disappeared. Voters instead were unnerved by the sight of an impulsive and mistake-prone candidate barely able to contain his rage.

By contrast, Obama was seen as "unflappable," in short, the type of person you would want first on the scene if you happened to be pinned under a car about to explode.

The rest is history.

Obama's much-vaunted even temperament is about to be put to the supreme test. He may rise to the occasion. He may cave under pressure. Either way, close observation will provide us with no end of insight into facing the challenges of our own illness.

The rest of the world may be looking for Obama to lead us out of the current economic crisis and other messes. Me? Next time I'm about to scream at tech support, I'm likely to remember to breathe, then ask myself: "What would Barack Obama do in my situation?"