Jeb Bush might have pledged to conduct his campaign “joyfully,” but it’s hard to see the modern-day presidential campaign—months on the road, relentless attacks, kowtowing to donors—as anything but joyless. And if you make it through all that, your prize is one of the most stressful jobs in the world. Why do they do it? To understand, Politico Magazine asked leading psychologists and psychiatrists to get inside the candidates’ heads and diagnose the urge to run. Is it narcissism? Masochism? Psychosis? Are presidential candidates just like the rest of us—or are they just out of their minds?

***


‘Grandiose narcissism levels are higher in more recent than in earlier presidents’

Research going back as far as 1998 suggests that modern politicians are more narcissistic than people in other professions. But in fact, politicians—at least those in positions of high power—might also be more narcissistic than ever. In a 2013 study published in Psychological Science, we and several colleagues examined a trait called grandiose narcissism, which comprises immodesty, boastfulness and interpersonal dominance (a certain presidential candidate in a gold-plated tower in Manhattan comes to mind). For every president up to and including George W. Bush, we asked eminent biographers and experts to complete extensive personality ratings for the five years before each president took office. The ratings revealed an intriguing trend: Grandiose narcissism levels are higher in more recent presidents than in earlier ones. Despite some caveats to this result, we also found that levels of several other traits, such as those linked to interpersonal oddity, were not higher in more recent presidents. Ultimately, our findings raise the possibility that the mounting pressures on candidates to be telegenic and adept at self-presentation may be selecting for heightened self-centeredness.

Rising narcissism levels in our politicians might be cause for concern. But today’s grueling campaigns might also select for such adaptive traits as emotional resilience, stick-to-itiveness and impulse control. Of course, even if a presidential candidate is driven partly by ambition, this does not mean he or she is not also driven by love of country. Even egomaniacs can be animated by a higher calling. —Scott Lilienfeld and Ashley Watts, professor and graduate student in psychology at Emory University

***

‘The winner every time has been the most hypomanic’

People who have the grandiosity to believe they are destined to lead the free world, the energy to mount a relentless campaign and the charisma to inspire millions are often endowed with hypomania—a mildly manic temperament that is not an illness but has been described in psychiatry for a hundred years and runs in the families of bipolar patients. Hypomanics have infectious energy, aggressive drive, over-the-top confidence, rapid thinking and out-of-the-box creativity. They speak quickly and loudly, dominating conversations. But they are also impulsive, irritable, arrogant and prone to shocking errors in judgment. It is a double-edged sword, responsible for both improbable successes and self-destructive failures (see: Clinton, Bill).

Not all candidates fit this profile, but when they do, it gives them a secret weapon. In this campaign, Donald Trump is the classic hypomanic, and he has gained the edge by criticizing Jeb Bush for being exactly the opposite—“low energy.” In fact, if you watch every presidential debate since the first televised one between Richard Nixon and John F. Kennedy (with the exception of the Carter-Ford contest in the shadow of Watergate), the winner every time has been the more aggressive, energetic and confident one—in short, the more hypomanic. Maybe we are not that far from the world of our chimpanzee ancestors, where, Planet of the Apes-style, the most combative, dominant and vigorous becomes the alpha of the group. —John Gartner, private-practice psychologist, part-time assistant professor of psychiatry at Johns Hopkins University Medical School and author of In Search of Bill Clinton: A Psychological Biography

***

‘No reason to suspect aberration as a general rule’

A few months before the 1964 presidential election, the now-defunct Fact magazine surveyed the membership of the American Psychiatric Association about the personality of Barry Goldwater, the Republican nominee. The psychiatrists savaged Goldwater, calling him “warped” and a “paranoid schizophrenic” who harbored unconscious hatred of his Jewish father and endured rigid toilet training. This absurd analysis prompted the APA to formulate the Goldwater Rule, advising members that it is “unethical for psychiatrists to offer a professional opinion unless he/she has conducted an examination and has been granted proper authorization for such a statement.”

This is not to say that careful psychometric evaluations are invalid. In such studies, presidents (who were once candidates, of course) rate more highly than the average person in terms of narcissism. But there is no reason to suspect aberration as a general rule. A 2006 study by Duke University psychiatrists found that, over their lifetimes, presidents displayed no greater incidence of psychiatric diagnoses than the rest of the population. (The authors acknowledge that the raw data they had to rely on were not perfect and that politicians’ psychological difficulties, if they do manifest, may emerge as a result of the pressures of office.)

Still, for psychological insight on important political figures, we may do better to turn to biographers like William Manchester, Robert Caro and Lou Cannon. Beyond the obvious, and objectively documented, preponderance of ambition, outsized self-confidence and related traits in presidential candidates, anyone who offers fanciful theories about candidates’ psychological health or explanations of their foibles involving the neurotransmitter dopamine is probably just spinning. —Sally Satel, resident scholar at the American Enterprise Institute and lecturer in psychiatry at the Yale School of Medicine

***

‘Under the narcissist’s glittering façade is a well of insecurity’

There is a spectrum of narcissism—ranging from, at the healthy end, individuals with abundant self-esteem and ambition to, at the other end, narcissistic personality disorder, the essential characteristics of which are described in one edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) as: “a grandiose sense of self-importance or uniqueness, e.g., exaggerations of achievements and talents, focus on the special nature of one’s problems; preoccupation with fantasies of unlimited success, power, brilliance, beauty or ideal love; exhibitionistic need for constant attention and admiration; cool indifference or marked feelings of rage, inferiority, shame, humiliation, or emptiness in response to criticism, indifference of others, or defeat; and troubled interpersonal relationships, characterized by a lack of empathy, interpersonal exploitativeness, a sense of entitlement or expectation of special favors, and a tendency to fluctuate between extremes of idealization and devaluation.”

The cynical political junkie might say, “Well, all politicians are like that.” But increasingly, in this age of Facebook and selfies, more than 10 percent of the American population demonstrates self-oriented narcissistic traits, by some estimates, to the point that in preparing the 2013 DSM, the APA considered removing narcissistic personality disorder from the manual. What better arena for those seeking the limelight than the political arena? The task for the discerning voter, then, is to discriminate between the narcissist, who may be appealing on the surface but is running for egocentric reasons, and the genuine public servant. For the narcissist often has a glittering façade, but underneath is a well of insecurity; hidden in his never-ending search to prove his superiority are the seeds of public danger—the need to be perfect, the incapacity to accept constructive criticism and a sense of specialness and exploitativeness. —Jerrold Post, former director of the CIA Center for the Analysis of Personality and Political Behavior, director of the George Washington University Political Psychology Program and author of Narcissism and Politics: Dreams of Glory

***

‘Some presidents aspire to be great, more aspire to do well’

A grueling campaign isn’t the only thing you might suspect would ward off presidential aspirants. These days, anyone lucky enough to win the office is left to govern a country in which 72 percent of the population says politicians cannot be trusted, and the U.S. Postal Service (really!) has the highest performance rating of any government agency. Finding common political and policy ground is increasingly difficult, leaving presidents to make executive end runs around the system, which, when “successful,” only increase public distrust and polarization.

Why would anyone want a job like this? During the 2008 election, Time magazine said it had discovered the “dirty little secret” explaining the reason people vie for the White House: “candidates are ambitious.” It’s hardly a secret that presidents have stronger ambitions than the average American. Yet that doesn’t get us very far in explaining why each presidency is so different from the next. The deeper, more important fact is that presidents vary enormously in their levels of ambition and the purposes to which they aspire to use it.

Some presidents aspire to be great, like Barack Obama, who wished to “transform” America, or Lyndon Johnson, with his Great Society; they organize their presidencies around the big policies they hope will cement their “great man” status in history. More commonly, presidents aspire to do well. These include figures as politically and ideologically diverse as Dwight Eisenhower, Jimmy Carter, Ronald Reagan, Bill Clinton, and both George H.W. and George W. Bush—leaders who leave their mark primarily during their time in office, rather than aiming to change the course of history. But while some candidates might enter the race because they imagine their likeness on Mount Rushmore, it would be more useful for the next president to channel his or her ambition toward rebuilding America’s damaged sense of trust in government. —Stanley Renshon, professor of political science at the City University of New York, certified psychoanalyst and author of The Psychological Assessment of Presidential Candidates



***

‘You do need a healthy amount of overconfidence’

I don’t think you need to be crazy to run for president, but you do need a healthy amount of overconfidence, an interesting attribute in and of itself. When we think about overconfidence, on the one hand, it’s potentially devastating for the individual. Imagine an overconfident person opening a restaurant. They think they’ll be successful, they spend lots of money, time and effort. Then, odds are, it doesn’t work out, and that money, time and effort are lost. For society, though, it’s a good thing that there are overconfident people, including the many presidential candidates this campaign season. We know that only one will be successful. But even if most of them fail, we are better off if more people compete, just as we are better off if there are people who start different restaurants: We get a broader range of opinions—more variety .

What’s more, what we often think of as craziness in politicians might in fact be a deep sense of mission. Imagine a graph with risk plotted on one axis and meaning plotted on the other. The presidential candidate, despite the risks and rigors of campaigning, stands to gain a great deal of meaning, if he or she can win, in terms of personal achievement and satisfaction. But there are lots of other professions out there—firefighter, police, the military—in which people make even bigger sacrifices out of a sense of mission, while deriving probably less meaning than the president does. So, not only are candidates not crazy; they’re not even the most extreme members of society in terms of the human desire to serve, even suffer, and create meaning in this process. —Dan Ariely, professor of psychology and behavioral economics at Duke University, author of The (Honest) Truth About Dishonesty and co-producer of the film (Dis)Honesty: The Truth About Lies



***

‘Resilience can help candidates cope’

There are three dominant qualities, psychologically speaking, that might lead someone to seek the presidency. First is narcissism, which in its adaptive form translates into self-confidence and entitlement. Second is grandiosity, which refers to the scale of one’s goals and ambitions; you can’t find a position bigger than the presidency. Finally, there is the sense that one is messianic—in this case, a person’s belief that he or she has a role to play in protecting and improving the country.

On top of these qualities, endurance and resilience can help candidates cope with the physical and psychological demands of the campaign and the pressures of the presidency. Presidential candidates also tend to fare better when they can exercise the cognitive qualities of control, the ability to manage emotions; compartmentalization, separating issues and incidents in their mind and not letting them preoccupy them when they need to focus on other parts of their job; and “reframing”—seeing issues and events, particularly adverse ones, from a different perspective.

Regardless of how mentally fit a candidate is, the enormous toll that the presidential campaign and office take on a person makes me wonder if more shouldn’t be done to assess and provide care for the psychological well-being of our candidates and officeholders. John F. Kennedy and Richard Nixon both took psychotropic medication for various psychological ailments. Ronald Reagan clearly was not the same following his assassination attempt, and his second term appears to have overlapped with his development of Alzheimer’s disease. In the same way that steps are taken to vet and ensure the physical health of the president (and those who aspire to the office), shouldn’t we do the same for their mental health? No matter how narcissistic or grandiose, they are, after all, only human. —Jeffrey A. Lieberman, professor and chairman of psychiatry at the Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, former president of the American Psychiatric Association and author of Shrinks, The Untold Story of Psychiatry



***

‘They are a lot like us’

At this point in the quadrennial ritual of presidential primaries, many of us shake our heads at the spectacle. Politicians? They must be narcissists. They’re all crooks and liars. They are just puppets for big money interests. No matter the formulation, the underlying assertion is the same: These people are a different breed.

I’ve come to the conclusion that the opposite is true—more than I care to admit. Are politicians the only people who try to tell their story in a way that will appeal to others (voters, bosses, friends, lovers)? Who spend much of their time trying to get people to put money in their pockets? Are politicians the only people who exaggerate their résumés? Who use networks or friends and acquaintances to gain an advantage? Who lie to preserve, protect, promote or perpetuate a cause they believe is right, just or superior? Nope. We all do that. Occasionally, frequently or most of the time.

So why do we pretend that politicians are different? Perhaps it is comforting to believe that these behaviors, many of which we might be ashamed to admit we do, exist only in a small, dark, historically smoke-filled place populated by people with different morals and agendas—just as we might be comforted in the belief that all mental illness resides in an asylum and all criminals are behind bars. I’m convinced that politicians not only represent us in legislatures and congresses, but also represent our greed, idealism, xenophobia, generosity and bigotry. They garner support not primarily for their policies but for behaviors we recognize because they are in us, too. They express, in public, what we know to be true about ourselves in private. By seeing politicians as “other,” we may save ourselves from some disturbing truths. But it’s not so. They are a lot like us. —David Berg, organizational psychologist and clinical professor of psychiatry at the Yale School of Medicine



***

‘Power, affiliation and achievement’

One way to understand why candidates endure presidential campaigns is to analyze their motives for holding the office. My years of research examining the language and imagery they use, particularly in announcement speeches and inaugural addresses, suggests there are three primary dimensions to what motivates presidential candidates: power, affiliation and achievement.

Power—the desire to have an impact on other people and the world at large—is perhaps the most obvious. In my research, candidates whose announcement speeches scored higher in power motivation were energetic grassroots campaigners, with relatively extreme ideological views (left or right), who stayed in the race even when their chances dropped. In office, power-motivated presidents—for instance, Abraham Lincoln and Franklin D. Roosevelt—tend to make decisions that have a great impact on the country and the world, so that they are rated as “great” by historians. On the other hand, during their presidencies the country has been more likely to be involved in war.

Other candidates see the presidency as an opportunity for affiliation—to “bring us together” and perhaps also to gratify a personal need to be loved. Richard Nixon was a curious example: warm and friendly with close friends, but awkward, suspicious and vindictive to those who disagreed or were different from him. Like Nixon, affiliation-motivated presidents are often involved in scandal, probably because they are readily influenced by others. On the other hand, they tend to seek peace through arms-limitation agreements with other major powers.

Finally, some candidates and presidents are driven by the desire to achieve—to innovate, compete and excel. They tend to run their campaigns like efficient companies, taking moderate ideological positions and focusing on raising money from a small number of major donors. Still, achievement-motivated presidents, such as Woodrow Wilson and Jimmy Carter, often discover that they have only limited influence and control over Congress, the federal bureaucracy and state governments, a fact that can drive them to frustration, micromanagement, cutting corners and exhaustion.

Each of these motives can be found in ordinary people—presidential politics just gives candidates a bigger and more public field on which to play out their motives. Extreme scores on each motive can certainly lead to vulnerabilities and pathologies—in presidents and in ordinary people, too. —David Winter, professor emeritus of psychology at University of Michigan



***

‘Extreme narcissism might be just what candidates need to get elected’

Narcissism in our presidents is nothing new—Lyndon Johnson, Teddy Roosevelt and Andrew Jackson all exhibited elevated levels—but what seems to have changed in recent years is that candidates take less care to cloak their narcissism within the old language of civic duty and self-sacrifice. This trend has coincided with a perhaps more disturbing one: the entry of what I call “extreme narcissism” into the fray. Extreme narcissists—those closer to but just short of narcissistic personality disorder along the narcissism spectrum—have little or no empathy for others and view the world almost exclusively in terms of winners (themselves) and losers (everyone they despise).

There’s no shortage of narcissistic candidates extolling their own virtues and relentlessly seeking the spotlight (think Ted Cruz and his faux filibuster), but Donald Trump is the most obvious example. In debates, he regularly delivers a one-two punch of self-aggrandizement followed by contempt for everyone else. “I’m a winner,” he announces, boasting about his wealth and business acumen, then referring to his opponents quite literally as “losers.” Or idiots. Or ugly. For the extreme narcissist, the truth is irrelevant. He becomes indignant at being challenged, blames his critics or detractors, and treats anyone who presumes to challenge him with utter contempt. (Just ask Megyn Kelly or Carly Fiorina.)

Many of our past presidents were most certainly narcissists. But today, the assault weaponry of extreme narcissism has come to dominate political discourse in our country. We’ve become an uncivil society, increasingly relying on indignant rage, blame and contempt for the other side to shore up our own points of view. Extreme narcissism, in other words, might be just what candidates need to get elected. —Joseph Burgo, psychotherapist and author of The Narcissist You Know: Defending Yourself Against Extreme Narcissists in an All-About-Me World

***

‘Narcissism also has major upsides’

George Washington might have modeled selflessness, explicitly refusing to be anointed king of a monarchy. But today, when the presidency is a commodity won after a brutal competition, leadership often inevitably coexists with narcissism. Candidates must be media savvy, power-seeking and immune to criticism, not to mention willing to sacrifice their friends and family for the greater good of the campaign

As expected, presidential narcissism has its downsides. Narcissistic presidents have highly flexible ethics—what is “is”? —and are judged by historians as less honest and more likely to engage in illicit romantic relationships or potentially criminal acts. The scandals are entertaining to watch, but they are neither a source of pride or respect for American presidents nor beneficial for a functioning government.

But the surprise in the research is that narcissism also has major upsides, for presidents and possibly the country. Big, bold risks have big consequences. They are not always good, but they are often seen as great. Modern U.S. presidents rated high on narcissism include John F. Kennedy, Lyndon Johnson, Richard Nixon and Bill Clinton; the low end includes Jimmy Carter, Gerald Ford and George H. W. Bush. We might admire this latter group personally, but they do not have a track record of bold leadership. The dream president would have confidence, vision and a willingness to lead vigorously, but also the humility and wisdom to lead well. This is an exceedingly rare elixir, however, and one seldom seen in the modern presidency. —W. Keith Campbell and Jean M. Twenge, professors of psychology at the University of Georgia and San Diego State University and authors of The Narcissism Epidemic: Living in the Age of Entitlement