Hubris syndrome

Clinical Medicine, Aug 2008 by Owen, David

ABSTRACT - Hubris syndrome is associated with power, more likely to manifest itself the longer the person exercises power and the greater the power they exercise. A syndrome not to be applied to anyone with existing mental illness or brain damage. Usually symptoms abate when the person no longer exercises power. It is less likely to develop in people who retain a personal modesty, remain open to criticism, have a degree of cynicism or well developed sense of humour. Four heads of government in the last 100 years are singled out as having developed hubris syndrome: David Lloyd George, Margaret Thatcher, George W Bush and Tony Blair.

KEY WORDS: intoxication, isolation. messianic, power

'Hubris' is not as yet an accepted medical term. The most basic meaning, developed in ancient Greece, is simply as a description of an act: a hubristic act was one in which a powerful figure, puffed up with overweening pride and self-confidence, treated others with insolence and contempt. The individual seemed to derive pleasure from using his power to treat others in this way, but such dishonouring behaviour was strongly condemned in ancient Greece. In a famous passage from Plato's Phaedrus, a predisposition to hubris is defined: 'When desire irrationally drags us toward pleasures and rules within us, its rule is called excess [hubris]'.1

Hubristic behaviour has fascinated playwrights, no doubt because it provides the opportunity to explore human character within highly dramatic action. Shakespeare's Coriolanus is an excellent example. But the pattern of the hubristic career is one that will immediately strike a chord in anyone who has studied the history of political leaders. It is an occupational hazard for all leaders, whether political, business, military or academic, although not all such leaders develop the hubris syndrome. Many politicians at times, however, do manifest some characteristic of hubristic behaviour.

There are several defined categories of mental illness that may be related in part to a continuum around hubris syndrome: adult attention deficit/hyperactivity disorder (ADHD), substance abuse, which includes alcohol, hypomania, bipolar disorder, paranoid personality disorder, one of nine categories listed in the International classification of diseases (ICD)-10, and narcissistic personality disorder (NPD), one of 10 categories listed in Diagnostic and statistical manual of mental disorders (DSM-IV). Most of these have established genetic linkage.2-9 A linkage which 'confer vulnerability to disorder' but not necessarily the disorder itself. Peter Tyrer argues they would be better called personality diatheses.10

Personality disorders tend to appear in late childhood or adolescence and continue into adulthood. A study in 2006 found that they affect nearly 4.4% of people in the UK.11 Hubris syndrome is different in that it usually manifests itself later in life and should not therefore be seen as a personality disorder but as an illness of position as much as of the person.

Hubris syndrome

Hubris syndrome is inextricably linked with power, indeed power is a prerequisite, and when power passes the syndrome will normally remit. The outcome seems to bear some relationship to the length of time that the individual has been in command. It evolves and is best understood as being a continuum with normal behaviour. The behavioural symptoms in a head of government which might trigger the diagnosis of hubris syndrome typically grow in strength and at least three or four symptoms from the following tentative list should be present before any such diagnosis be contemplated:

* a narcissistic propensity to see the world primarily as an arena in which they can exercise power and seek glory rather than as a place with problems that need approaching in a pragmatic and non-self-referential manner

* a predisposition to take actions which seem likely to cast them in a good light, taken in part in order to enhance their image

* a disproportionate concern with image and presentation

* a messianic manner of talking about what they are doing and a tendency to exaltation in speech and manner

* an identification of themselves with the nation to the extent that they regard the outlook and interests of the two as identical

* a tendency to talk of themselves in the third person or use of the royal 'we'

* excessive confidence in their own judgement and contempt for the advice or criticism of others

* exaggerated self-belief, bordering on a sense of omnipotence, in what they personally can achieve

* a belief that rather than being accountable to the mundane court of colleagues or public opinion, the real court to which they answer is much greater: History or God; often accompanied by an unshakeable belief that in that court they will be vindicated

* restlessness, recklessness and impulsiveness

* loss of contact with reality, often associated with progressive isolation

* a tendency to allow their 'broad vision', especially their conviction about the moral rectitude of a proposed course of action, to obviate the need to consider other aspects of it, such as its practicality, cost and the possibility of unwanted outcomes