Lord David Owen has written extensively about politicians and heads of state who became insufferable from being intoxicated by the power of their office. He called this aberration from gentlemanly behavior the hubris syndrome, an acquired personality disorder that most often went away after they left office. Hubris has come down to us from the ancient Greeks. It means arrogance, excessive pride, an overestimation of one’s capabilities. It affected Prometheus, the putative benefactor of mankind who challenged the supremacy of Zeus by stealing the fire from the heavens and was punished by being chained to a mountain in the Caucasus where a vulture feasted on his liver during the day but it regenerated during the night. Hubris exists as an everyday phenomenon in all ways of life and all professions. It has felled entrepreneurs who planned grandly but failed miserably by overestimating their knowledge, foresight, and ability. It is common among high-level executives who exhibit excessive levels of confidence, self-potency, and the conviction that they will prevail. It is possible that a healthy dose of innate hubris is a necessary ingredient for success in leadership, business, research, or politics.

Being a neurologist and former British minister of health, Lord Owen has medicalized what some would argue is not medical at all. He would most certainly have displeased the late Ivan Illich, who deplored the medical establishment’s takeover of too many activities of ordinary life. But as a good scientist he used the term syndrome to describe a condition that can be produced by many different pathological processes, an approach lauded as early as 1949 by Sir Harold Himsworth, who in his Oliver-Sharpey lectures emphasized the liberation of medical thought brought about by the substitution of syndromes for “disease” to designate specific illnesses. Starting from organic medicine, the concept of syndromes spread to psychiatry, to psychology, and hence to politics, business, and public affairs.

So how did Lord Owen describe his medicalized syndrome? Focusing largely on prominent politicians and heads of state, he emphasized how politicians’ long power became domineering, autocratic, messianic, often irrational and impulsive, to the great detriment of their country. Accordingly, the hubris syndrome is defined as an acquired personality disorder constituted by a constellation of varying behavioral characteristics, of which the presence of a certain number would appear to be required to make the diagnosis. Persons afflicted by the hubris syndrome see the world as an arena in which to exercise power and glory; may take actions likely to cast them in a good light; have a disproportionate concern for their image; develop a messianic zeal and exaltation in speech, often talking about themselves in the third person and using the royal “we” in conversation. Their interests become the same as those of the nation; they place excessive confidence in their own judgment; display contempt for the advice and criticism of others; harbor a feeling of omnipotence, and believe that their actions will be vindicated if not in this world in the court of history or of God. They may become restless, reckless, impulsive, often losing contact with reality and no more considering the practicality, cost, or consequences of their endeavors; and may display a certain degree of incompetence in carrying out their policy. As this is most certainly a full plate, Lord Owen suggested that the full syndrome requires a defined number of criteria; and that some persons, while not displaying the full syndrome, had only hubristic traits or behavior.

For examples of the full syndrome one need go no further than Margaret Thatcher, eventually so difficult and messianic and bearing no contradiction that her own party deposed her. During World War II General de Gaulle exhibited grandiose ideas and identified his own self with the destiny of France. Napoleon and Hitler in their overconfidence took on too many adversaries and fatally invaded Russia; Mussolini, Mao, Stalin, and Khrushchev may also qualify. Going one step further, Lord Owen attempted to define a pure hubristic syndrome by excluding psychosis, depression, alcoholism, and other coexisting conditions, as well as characterizing some potential candidates as manifesting only hubristic traits.

In subsequent publications, Lord Owen analyzed the history of the presidents of the United States and the prime ministers of Great Britain over the past one hundred years. Regarding the presidents, he excluded as not affected Harry Truman, Dwight Eisenhower, Gerald Ford, and Ronald Reagan. In Theodore Roosevelt he detected some hubristic traits, but thought that a bipolar type 1 disorder was also present. In Woodrow Wilson he found a complicated medical history entangled with pre-existing chronic anxiety and depression, complicated later by cerebral vascular disease, but also recognized a possible hubristic syndrome in that he has been described as defensive, egocentric, suspicious, stubbornly self-righteous, certain in his views, rigid in his thinking, and tending to enhance his authority and exercise it without restrictions. Franklin Roosevelt came close to being taken over by hubris in 1937, when he engaged in a battle with Congress over the nomination of justices to the Supreme Court. Kennedy displayed occasional hubris; Lyndon Johnson had severe depression and a family history suggestive of bipolar disorder, but his megalomaniac behavior could at times have qualified as being hubristic. Richard Nixon began to behave hubristically in 1972, exhibited hubris and paranoia after his reelection, but his behavior was complicated by depression and alcoholism. Among the British prime ministers Lord Owen found some hubristic traits in Asquith, Lloyd George, Neville Chamberlain, and to some extent in Winston Churchill, who may also have suffered from bipolar disorder and manic behavior, periodic depression, and in old age vascular dementia and alcoholism. Writing at the time of the Iraq war, Lord Owen diagnosed hubris in the two major protagonists of the war, George W. Bush and Tony Blair.

By drawing attention to behavior commonly seen in leaders of nations, Lord Owen has made an important contribution. He indeed made a distinction between hubristic behavior or traits on one hand and the pure hubristic syndrome on the other. But how pure such a syndrome can be requires further exploration, considering the frequent coexistence of depression, mania, alcoholism, or paranoia. It may also be unhelpful to lump together all the possible variations of this syndrome. Lord Owen importantly highlighted the case of the politician long intoxicated by power and wishing to hold on to it, for personal reasons or to accomplish a mission. But compare this with the more transient situation of a leader facing an unusually difficult or extraordinary situation. How different the case of John Kennedy when confronted early in his tenure by the danger of nuclear war! Or of George W. Bush, always polite and listening to the counsel of his advisers, when in the brief moment of exultation over a rapid military victory he declared mission accomplished. Only time will tell whether the hubris syndrome as formulated by Lord Owen will survive the shifting sands of psychiatric classifications, or whether future medicalizers will sympathetically distinguish between long-lasting behavior aberrations and the circumstances surrounding a brief moment in history.