A Lesser-Known Legacy: Paul Ekman’s Contributions to Health Psychology
In the wake of Dr. Paul Ekman’s passing, many have reflected on his groundbreaking work in facial expression, emotion, and deception. Yet as Dr. Erika Rosenberg (one of Dr. Ekman’s students, collaborators, and longtime friends) reminds us, there is a powerful chapter of Paul’s scientific legacy that remains less widely known: his contributions to health psychology and our understanding of the connection between emotion and heart disease.
Article Highlights
- The FACS Connection: How the Facial Action Coding System identifies cardiac risk.
- Type A Behavior: Moving beyond personality traits to visible behavioral markers.
- The “Hostile Glare”: A specific facial expression linked to coronary-prone individuals.
- Mind-Body Data: Linking facial expressions of anger to silent myocardial ischemia.
Dr. Rosenberg first began working with Dr. Ekman in 1988 as a graduate student at the University of California, San Francisco. Over the next 37 years, Paul would become not only a mentor, but a close friend and one of the most influential figures in her life. In reflecting on his work, she highlights how Dr. Ekman’s expertise in facial expression analysis helped advance research into emotion and cardiovascular health.
Bringing Facial Action Coding System (FACS) Into Health Research
Health psychology focuses on how psychological and emotional factors influence physical illness and disease. In the late 1980s and early 1990s, Dr. Ekman became involved in research on Type A behavior patterns, a set of traits associated with increased risk for coronary heart disease. While Type A behavior had been linked to heart risk, the mechanisms behind it were poorly understood.
Collaborating with researchers including Dr. Margaret Chesney, Paul applied the Facial Action Coding System (FACS) to interviews with individuals diagnosed with Type A behavior. This work, utilizing quantitative facial coding, revealed a striking and consistent facial pattern that distinguished those who were coronary-prone from those who were not: a targeted hostile glare.
This facial display is marked by lowered brows, lifted upper eyelids, and tension in the lower eyelids. It appeared during interpersonal interaction and was directed at another person, signaling focused hostility. This discovery helped identify a visible, measurable behavioral marker associated with cardiac risk, providing a repeatable method for assessing health risks beyond self-reported surveys.
Linking Emotion on the Face to the Heart
“This was the first time anyone had been able to link specific emotions to deleterious cardiac events—showing how what we express on our faces can be directly connected to what’s happening in the heart.”
— Dr. Erika Rosenberg
Building on this work, Dr. Rosenberg conducted her doctoral research in collaboration with Paul and researchers at Duke University, taking the science a step further. Using cardiac imaging, the team examined what was happening inside the heart while individuals were experiencing emotional stress.
Specifically, the research focused on silent transient myocardial ischemia, a condition where heart blood flow is restricted without outward symptoms. These events may not be felt, but they are observable, and are clinically significant as they are known predictors of cardiac morbidity and mortality.
During a structured, provocative interview designed to elicit emotional responses, the researchers were able to link facial expressions with heart activity. By using cardiac imaging and FACS simultaneously, the study provided empirical evidence that emotional triggers manifest as visible facial micro-expressions before or during adverse cardiac wall motion events. The findings were groundbreaking: moments when the heart showed signs of ischemia (measured through changes in left ventricular function and cardiac wall motion) were consistently linked to facial expressions of anger. For the first time, researchers were able to directly connect a specific emotion, visible on the face, with harmful physiological events occurring in the heart.
A Lasting Impact on Science and Medicine
This work marked a pivotal moment in health psychology. It demonstrated that emotional expressions (particularly anger) are not merely psychological experiences, but are intimately tied to physiological processes that can influence disease progression and risk of death.
As Dr. Rosenberg reflects, this body of research stands as an important, though often overlooked, contribution of Paul Ekman’s career. It exemplifies his unique ability to bridge disciplines, deepening our understanding of how emotions shape not only our inner lives, but our physical health and longevity.
Paul Ekman’s legacy continues to live on in the science he advanced, the students he mentored, and the lives potentially benefitted through a clearer understanding of the link between emotional and physical health.
