Finishing third in a contest that just a few weeks earlier he had been expected to win handily is surely a setback for the campaign of Howard Dean. But in the long run, Dean's Iowa concession speech, in which he appeared to lose control of himself and began screaming at supporters — all in front of dozens of television cameras — may be even more damaging.

Dean's speech, delivered at his headquarters in Des Moines, stunned even some observers used to his displays of anger on the campaign trail. And in the days after the caucuses it is sure to spark discussion of Dean's emotional intensity and whether such intensity should be a disqualifying characteristic for a potential president.

The speech didn't start badly. Although Dean appeared oddly exuberant after what was an extraordinarily disappointing finish, that might easily be attributed to a politician's desire to put a publicly positive face on bad news. "You know something?" Dean asked his fans. "If you had told us one year ago that we were going to come in third in Iowa, we would have given anything for that."

That was a perfectly reasonable gloss for a candidate to put on unfavorable election results. But Dean quickly took on a red-faced, shouting, teeth-baring, air-punching demeanor unlike any of his performances during the campaign.

"Not only are we going to New Hampshire," he said, his voice rising. "We're going to South Carolina and Arizona and North Dakota and New Mexico, and we're going to California and Texas and New York. And we're going to South Dakota and Oregon and Washington and Michigan. And then we're going to Washington, D.C. to take back the White House."

Then he let out a strange, extended, yelp that seemed to come from deep within him: "YAAAAAAAAAAAAAARRRRHHHHHH!!!!!!!!!" Listen To MP3 Sound Bite Here

Dean resumed his roll of states. "We will not give up! We will not give up in New Hampshire! We will not give up in South Carolina! We will not give up in Arizona or New Mexico, Oklahoma, North Dakota, Delaware, Pennsylvania, Ohio, Michigan! We will not quit now or ever! We'll earn our country back for ordinary Americans!"

As the crowd began to applaud, Dean recited still more states. "And we're going to win in Massachusetts! And North Carolina! And Missouri! And Arkansas! And Connecticut! And New York! And Ohio!" — the home states of Dean's rivals for the Democratic nomination.

At times in his speech, Dean's demeanor seemed that of a man who was not aware of how he looked to outside observers. In the last days of the Iowa contest he had undergone the extreme stress of a candidate losing control of a campaign he had once dominated. His reaction to the loss in Iowa brought to mind statements Dean made on January 8, in an interview with People magazine, in which Dean discussed the emotional difficulties he has sometimes had dealing with stressful situations.

In the interview, Dean discussed how, as a medical student, he encountered difficulties when he had to treat a nine year-old victim of a drive-by shooting. Dean denied suggestions that he froze up, but said, "I discovered that my really intense emotional empathy just made it hard for me to do the things that had to be done."

People reporter J. D. Heyman then asked about later anxiety attacks Dean had suffered. "What were those like?"

"It was not a big deal," Dean responded. "I was just anxious and I didn't know why."

"So it was a paralyzing — "

"No, not a bit," Dean answered. "I didn't miss a day of work. I didn't worry about what was going to happen. I just wasn't sure what was going on and then I traced it to my brother [who had disappeared in Laos]."

"Through counseling?" Heyman asked.

"Yeah," Dean said.

"Was it just talking it through or were you ever medicated?"

"No. It was just anxiety."

"Well, today, you say the word 'anxiety' and there are eight or nine different anti-anxiety drugs — " Heyman said.

Dean explained that he is "not a big fan of most anti-anxiety drugs." He said he occasionally takes "stuff for sleep," but "anti-anxiety drugs and sleep drugs were essentially the same thing when I was practicing. And my experience was whenever I took a sleeping pill, there would be rebound insomnia and so I didn't like to take them."

Heyman asked, "And since then, it was as if you went in, you took care of the problem and that has never been a problem since?:

"No," said Dean. "That was in the early eighties."

"It sounds as if you had a little bit of an anxiety attack when you got the word that you were now governor," Heyman said.

"I did," Dean answered. " I hyperventilated and I started hyperventilating and I thought, 'You better stop that or you won't be much good to anybody.'"

"Has that happened since, or before?"

"No."

"Why was that such a — "

"To suddenly get told that you have responsibility for 600,000 people — it provokes a little anxiety."

"But now you're asking for responsibility for 250 million and then, the global reach of the U.S. presidency. That doesn't provoke a little anxiety?"

"No," Dean answered. "I mean I wouldn't be doing it if I didn't — First of all, I think everybody has a little anxiety when they approach a job like that." Dean then explained that as a doctor and as governor, he had made many hard decisions, sometimes involving life and death.

Throughout his campaign, Dean has been an emotionally volatile candidate. He has made anger a feature of his campaign, with the exception of a few days toward the end of the Iowa contest when he tried to adopt a more statesmanlike approach (a strategy he soon abandoned). In the face of questions about his tone, Dean denied that he was angry and claimed that his campaign was in fact about hope. But now, following his nearly over-the-top performance in his concession speech, the questions will return.