Mr. Putin, tell me about yourself
Hubris syndrome and its characteristics
Unlike most personality disorders, which appear by early adulthood, we view hubris syndrome as developing only after power has been held for a period of time, and therefore manifesting at any age. In this regard, it follows a tradition which acknowledges the existence of pathological personality change, such as the four types in ICD-10: enduring personality change after trauma, psychiatric illness, chronic pain or unspecified type (ICD-10, 1994)-although ICD-10 implies that these four diagnoses are unlikely to improve.
Initially 14 symptoms constituting the hubristic syndrome were proposed (Owen, 2006). Now, we have shortened and tabulated these descriptions and mapped their broad affinities with the DSM IV criteria for narcissistic personality disorder, antisocial personality disorder and histrionic personality disorder. These three personality disorders also appear in ICD-10, although narcissistic personality disorder is presented in an appendix as a provisional condition, whose clinical or scientific status is regarded as uncertain. ICD-10 considers narcissistic personality disorder to be sufficiently important to warrant more study, but that it is not yet ready for international acceptance. In practice, the correlations are less precise than the table suggests and the syndrome better described by the broader patterns and descriptions that the individual criteria encapsulate.
Previous SectionNext SectionEstablishing the diagnostic features of hubris syndrome
The nosology of psychiatric illness depends on traditional criteria for placing diagnoses in a biomedical framework (Robins and Guze, 1970). There are, however, other underpinnings-psychological or sociological-that can be applied. Validity for a psychiatric illness involves assessing five phases: (i) clinical description; (ii) laboratory studies; (iii) defining boundaries vis-a-vis other disorders; (iv) follow-up study; and (v) family study. While these phases are worth analysing, it has to be recognized that there are severe limitations in rigidly applying such criteria to hubris syndrome given that so few people exercise real power in any society and the frequency amongst those ‘at-risk’ is low. The potential importance of the syndrome derives, however, from the extensive damage that can be done by the small number of people who are affected. As an investigative strategy, it may be that studies such as neuroimaging, family studies, or careful personality assessments in more accessible subjects with hubristic qualities or narcissistic personality disorder from other vulnerable groups might inform the validation process.
Previous SectionNext SectionProposed clinical features
Hubris syndrome was formulated as a pattern of behaviour in a person who: (i) sees the world as a place for self-glorification through the use of power; (ii) has a tendency to take action primarily to enhance personal image; (iii) shows disproportionate concern for image and presentation; (iv) exhibits messianic zeal and exaltation in speech; (v) conflates self with nation or organization; (vi) uses the royal ‘we’ in conversation; (vii) shows excessive self-confidence; (viii) manifestly has contempt for others; (ix) shows accountability only to a higher court (history or God); (x) displays unshakeable belief that they will be vindicated in that court; (xi) loses contact with reality; (xii) resorts to restlessness, recklessness and impulsive actions; (xiii) allows moral rectitude to obviate consideration of practicality, cost or outcome; and (xiv) displays incompetence with disregard for nuts and bolts of policy making.
In defining the clinical features of any disorder, more is required than simply listing the symptoms. In the case of hubris syndrome, a context of substantial power is necessary, as well as a certain period of time in power-although the length has not been specified, varying in the cases described from 1 to 9 years. The condition may have predisposing personality characteristics but it is acquired, that is its appearance post-dates the acquisition of power.
Establishment of the clinical features should include the demonstration of criterion reliability, exploration of a preferred threshold for the minimum number of features that must be present, and the measurement of symptoms (e.g. their presence or absence, and a severity scale). This endeavour may also include a decision as to whether the 14 criteria suggested might usefully be revised.
To determine whether hubris syndrome can be characterized biologically will be very difficult. It is the nature of leaders who have the syndrome that they are resistant to the very idea that they can be ill, for this is a sign of weakness. Rather, they tend to cover up illness and so would be most unlikely to submit voluntarily to any testing, e.g. the completion of scales measuring anxiety, neuroticism and impulsivity. Also the numbers of people with the syndrome is likely to be so small preventing the realistic application of statistical analyses. It also needs to be remembered that leaders are prone to using performance-enhancing drugs fashionable at the time. Two heads of government, Eden and Kennedy, were on amphetamines in the 1950s and 1960s. In the 21st century hubristic leaders are likely to be amongst the first to use the new category of so-called cognition enhancers. Many neuroscientists believe that such drugs properly used can be taken without harm. The problem is a leader who takes these without medical supervision and in combination with other substances or in dosages substantially above those that are recommended. In 2008, Nature carried out an informal survey of its mainly scientific readers and found that one in five of 1400 responders were taking stimulants and wake-promoting agents such as methylphenidate and modafinil, or β-blockers for non-medical reasons (Maher,2008).
In defining the boundaries, one of the more important questions may be to understand whether hubris syndrome is essentially the same as narcissistic personality disorder (NPD), a subtype of NPD or a separate entity. As shown inTable 1, 7 of the 14 possible defining symptoms are also among the criteria for NPD in DSM-IV, and two correspond to those for antisocial personality and histrionic personality disorders (APD and HPD, respectively) (American Psychiatric Association, 2000). The five remaining symptoms are unique, in the sense they have not been classified elsewhere: (v) conflation of self with the nation or organization; (vi) use of the royal ‘we’; (x) an unshakable belief that a higher court (history or God) will provide vindication; (xii) restlessness, recklessness and impulsiveness; and (xiii) moral rectitude that overrides practicalities, cost and outcome.
View this table:
Table 1
The symptoms of hubris syndrome
In making the diagnosis of hubris syndrome we suggest that ≥3 of the 14 defining symptoms should be present of which at least one must be amongst the five components identified as unique.
rest of this story: http://brain.oxfordjournals.org/content/132/5/1396.full
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