The ‘hubris syndrome’ is of unquestionable interest but unfortunately the account given by Russell and Owen was lacking in sociopolitical and historical context. ^{Reference Russell1,Reference Lord Owen2} In addition, it was unhelpful to confound this putative syndrome with the impairment of a politician's decision-making as a result of physical or mental illness. These two phenomena are unrelated and must therefore be kept separate.

By contrast, Freedman's comments ^{Reference Freedman3} were more nuanced and took account of the complexity of this interesting phenomenon. Freedman pointed out the important distinction that must be made between leaders in democratic and non-democratic systems. Whereas egalitarian systems of leadership appear to have been prevalent among pre-Neolithic hunter-gatherers, ^{Reference Boehm4} following the advent of agriculture more tyrannical forms of leadership become the norm. Certainly since the rise of the state some 5000 years ago the most common systems of governance have been autocratic or tyrannical. ^{Reference Abed5} The checks and balances that leaders in a democratic system (a very recent historical development) have to endure, although imperfect, severely limit their ability to indulge in the kind of hubris that their tyrannical counter-parts can do. I suggest that the syndrome in its purest form should therefore be studied in autocrats and tyrants to correctly identify its full-blown manifestations. There is no shortage of candidates for such a study both historical and contemporary. It is of interest that the events taking place in many Arab countries at present involve the actual or attempted removal from power of a group of tyrannical leaders who represent extreme examples of the hubris syndrome. Any of these leaders would qualify as a case study of hubris syndrome.

It is debatable as to whether the syndrome is an illness or simply a human psychological phenomenon or response that results from the interaction of certain specific personality traits with the experience of power, authority and elevated status. It may even be argued that this syndrome has been a necessary qualification for all tyrants throughout history and that it has only become dysfunctional and maladaptive in democratic systems.