1. Frontotemporal Dementia: A Clue to the Biological Basis of Hubris Syndrome?

A range of theories have been put forward to account for the distinctive personality change that is sometimes observed after individuals in positions of power have enjoyed an extended period of successful and/or unchallenged authority. In this chapter, Peter Garrard explores the similarities between this phenomenon (which has come to be known as the Hubris Syndrome) and the development of grotesquely exaggerated, often self-destructive personality traits in response to damage in frontal brain regions. The idea that personality can be altered by focal physical changes to the brain has its roots in early clinical descriptions beginning with the celebrated case of Phineas Gage. In modern medical practice, however, the most dramatic cases emerge not following traumatic brain injury but in response to a slowly progressive degenerative process that, over years to decades, erodes the neuronal circuits of the brain’s frontal lobes, on which judgement, socialisation, moral reasoning, theory of mind, and other manifestations of high-level abstract cognitive processes, are dependent. Unravelling the complex combination of personality changes that are seen in the context of frontotemporal dementia is difficult, but description has been facilitated by the use of structured and systematic symptom questionnaires such as the Neuropsychiatric Inventory (NPI). The symptoms elicited by the NPI overlap with some of the changes of HS.