Podcast Review: July 2009 3rd Edition

The Royal College of Psychiatrists have a new Podcast featuring an interview between Peter Tyrer and the Right Honourable Lord Owen who discusses his new book on ‘The Hubris Syndrome: Bush, Blair and the Intoxication of Power’. Lord Owen together with Jonathan Davidson have also authored a paper in Brain on Hubris Syndrome earlier this year. Lord Owen has made a close study of many politicians and has identified an association of characteristics that impair the ability of the politician to function effectively – which he refers to as ‘The Hubris Syndrome’. Some of these characteristics overlap with those of the narcissistic personality disorder such as exaggerated self-importance, concern with image and presentation and a need to ‘exercise power and seek glory’. However Lord Owen refrains from giving this a formal diagnostic label and instead focuses on what he considers to be a significant problem when it does occur in politics given the consequences:-

This is a disease of power

What he suggests is that through the development of the Hubris Syndrome, the politician may become isolated from the influence of those around them leading to a characteristic type of mistake which he refers to as ‘Hubristic Incompetence’. Professor Tyrer is able to bring his interest  in Nidotherapy to bear on this and the intriguing issue of how much of this results from the artificial environment in which politicians may find themselves is raised. This is an important discussion given the number of lives such characteristics may affect**.

Acta  Psychiatrica Scandinavia have started a Podcast series featuring interviews with prominent psychiatrists. In this episode, Professor Jules Angst talks about his experience of organising different trials and raises a number of profound points about research. For instance he suggests that the placebo-controlled trial is no longer realistic as it is unethical during such trials to administer placebo to those with severe illness. Therefore such trials involve people with milder forms of illness rather than the full spectrum of people that are seen in clinical practice. His points about selection bias in treatment-seeking behaviour and risk aversiveness in society relating to innovation in pharmaceutical trials is also thought provoking.  Angst raises a number of issues which if addressed should lead to clinical benefits. One of the challenges that seemed to me to be particularly difficult was that of innovating with drug research. The large costs of drug trials present a significant barrier to innovation and it will be interesting to see if any viable solutions can be created to overcome these barriers*.

* Computer simulations are one possibility. For instance models of the organs of the body have been created and have been used to simulate the physiological effects of compounds. These types of simulations however would be more helpful in identifying agents which might be successful but will not negate the need for the expensive trials themselves. Perhaps as routine clinical practice incorporates more outcome measures, research might more easily become part of clinical practice and reduce the associated costs as the clinical infrastructure develops.

** It is tempting to consider this from an evolutionary perspective and I will speculate a little here although it must be borne in mind that this is nothing more than speculation and may ultimately bear little relevance to the issues. Some of our nearest primate relatives display human-like features which discriminate their status within the local community.  It is not unreasonable to suppose that these have been conserved if they present similarly. The need for politicians in a society suggests that some of these evolutionary adaptive mechanisms are being employed to satisfactorily solve society’s problems when that society reaches a certain population threshold. So in small groups, we may easily manage relationships and even as the numbers reach 20 or 30. Beyond this number there may come a point at which our brains are no longer suited to allow us to act harmoniously without the use of environmental mechanisms. Indeed optimal group sizes have been identified in the workplace and some suggestion has been made that they relate to the size of working memory although there may be altogether more subtle mechanisms at work. Thus politics may be the way in which society organises itself to take advantage of the brain’s evolved properties so as to effectively serve the needs of a large society (There are three many evolutionary drivers for these properties which have been associated with politics). When society looks at the behaviour of politician’s it is in effect looking at human behaviour with all of its perceived strengths and weaknesses but perhaps it is all of these combined which are the necessary features for effective functioning. To remove any part of this naturalistic environment may reduce the functional effectiveness of this environment because the brain is no longer presented with the type of information it has adapted to ‘solve’. If  evolution has occurred over some 3 billion years, then it may be some time before all of the intricacies of the optimal environment are elucidated although the brain itself may be capable of directing the creation of this environment. The above could be rephrased as – ‘politics is the creation of the optimum environment to facilitate the optimal functioning of a group of politician’s to serve the needs of a large population using the full gamete of their brain’s problem-solving (and other) properties which in turn result from over 3 billion years of evolution’. By drawing further on the evolutionary analogy it can be argued that money is the equivalent of food – part of the environment which drives fitness-related behaviours and that if there are larger numbers of candidates to choose from, certain properties of this environment may be more pronounced. Returning to the ‘Hubris Syndrome’ and the adaptive mechanisms which may be relevant.

These mechanisms would be many and varied and it may be that the ‘Hubris Syndrome’ represents a breaking down of these adaptive mechanisms. The politician has a surrounding group of people that are considered to be the ‘political machinery’ that makes governance effective. The politician influences and in turn is influenced by those around them and perhaps the ‘Hubris Syndrome’ reflects a breakdown of this influencing paradigm. Since it is a syndrome there may be a large number of causes from different domains. Thus there may be external influences or internal factors that impact on the interplay with the surrounding group. The surrounding group is optimally placed to monitor the quality of these interactions and would respond adaptively. If there is a breakdown in this interplay, then providing all other parts of the political machinery are functioning effectively, there is a risk to the appropriate meeting of society’s needs. By adopting this model, it is possible to see that there are a number of variables which are of importance. If the interplay is important, then this could be measured periodically using appropriate outcome measures. The feedback could be used to modify behaviour or attitudes and inform learning objectives to improve performance, would be multilayered from the surrounding group as well as society. Such feedback and learning resources should be commensurate with the value placed on these roles by society.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

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