Narcissistic Sociopathy in Global Autocratic Leaders: Arrested Development, Obsessive Demand for Power, and the Emergence of Unlawful Hybrid Wars

Abstract There are several reasons why war occurs. The most lethal wars are those caused by 1 man’s decisions solely driven by an obsessive need for power. With disregard for International Humanitarian Law and the Geneva Convention, these wars, referred to as hybrid warfare, purposefully target civilians directly resulting in millions of deaths, injuries, mass migration, and other severe global and public health consequences. The purpose of this commentary is to investigate the developmental nature of those decision-makers and the consequences of their acts of aggression both locally and globally. There is a clear relationship between the psychological developments of individuals with narcissistic and psychopathological disorders and the implications of an abnormal progression of these individuals and their obsessive desire for singular leadership, which seriously impacts health-care security and its essential elements provided by international humanitarian law and Geneva Convention. Current double standards of the West allow narcissistic sociopaths and autocratic leaders to neglect international law, especially the so-called international humanitarian law. This double standard must be ceased and replaced by an international investigative system with universal standards, a special tribunal covering hybrid war crimes as well as the crime of aggression, and to prevent future leaders from choosing the same strategies.

Economic gain, territorial disagreement, differences in religious beliefs, strong nationalism, revenge, internal disagreement, and ideological beliefs can all cause excessive violence and war. They share a common denominator, ie, "Power." 1,2 Most wars are initiated because of 1 country's systematic, seemingly rational, and sometimes unintentional search for more power to ensure its sovereignty. However, such actions are often interpreted as a threat by neighboring countries and lead to cross-border wars. Other wars begin because of power struggles between 2 diverse ideological groups, using societal means and reasons as the triggering points. Finally, there are also wars caused by 1 person's decisions often based on his or her personal, emotional, and exceptional understanding of threats, national interests, and the need to keep the power to maintain political order. [2][3][4] One man's decision for starting a war is seldom beneficial for the masses and is often biased. For example, by signing decrees ordering military forces into 2 separatist regions of Ukraine for "peacekeeping" purposes, recognizing the regions' independence, President Putin both launched the conflict and decided the legal outcome as only a dictator can do. Such actions are a clear violation of the territorial integrity and sovereignty of Ukraine that all nations enjoy under international law. This interferes directly with the principles of the Charter of the United Nations (UN) and is inconsistent with the so-called Friendly Relations Declaration of the General Assembly, which the International Court of Justice has repeatedly cited as representing international law. Along with the negative impact on the Minsk Agreements endorsed by the UN Security Council, President Putin's selective interpretation of the role of peacekeepers in the Ukrainian conflict was a "perversion of the concept of peacekeeping." 5,6 Such unilateral action against another nation continues both with obsessive denial and newly defined Lawfare, ie, the direct misuse of existing law. These actions over the past several decades serve as a reminder of how a single decision-maker has successfully initiated several previous hybrid wars (ie, Syria, Chechnya), resulting in loss of lives, properties, and mass migration. [2][3][4] The environmental, psychological, and public health consequences of a hybrid war are extremely complex, unimaginable to many, with impacts that will remain unresolved for many generations to come. 7 Making a decision that affects so many lives, requires a personality that fails to understand and appreciate the perspectives of others; lacks conscience, empathy, guilt, anxiety, or sorrow; develops to maintain both a level of persistent arrogance that serves as a cover for his/her insecurity and a continuous search after power to control everyone and everything. 8 Identifying and reviewing several single decision-makers who have caused such conflicts in the past, this commentary's purpose is to describe the true face of the leaders/decision-makers, whose actions lead to hundreds of thousands of deaths and injuries, mass migration, and the acts of aggression imposed by unconventional measures such as targeting hospitals and health-care providers, beyond what we already accept as violations of International Humanitarian Law (IHL) and Geneva Convention (GC).

The Power and Its Impacts on Life
Power is defined by the Oxford dictionary as "the ability to control people or things." 9 The desire of having control is part of human development. It is widely known that the first 5 y of a child's life are crucial to later development, with impacts echoing throughout life. 8,10,11 Although children and young people may not be able to exercise influence or make decisions for themselves, the first sign of power may emerge at the age of 18 months when the toddler can express dissatisfaction by saying "NO." Exerting power can also be the reason why children misbehave. Feeling powerless and having no control over the situation, they seek power through their behaviors, eg, crying, screaming "No," refusing to comply, or throwing themselves on the ground. Although the word "power" can be associated with overbearing, and manipulative actions often occurring at the expense of others, it just means power to children who developmentally lack the skills and knowledge of having complete power over their lives. Such control is an intrinsic drive, a strong desire to make decisions and complete actions on our own. As children grow older, they attempt to avoid being powerless and find direct ways to grasp the control by using their behavior to either demand control or simply take it. 10,11 One important indication of a power struggle and its consequences can be interpreted as bullying. 12 Although there is no consensus on the definition, bullying behavior involves an intention to harm, repetition, and an imbalance of power. [12][13][14] The latter can relate to objective, observable factors such as age or size differences, which may change the dynamic of a group, in which someone with diverse characteristics is not welcome. It can also relate to more subtle factors such as lower popularity, lack of social support, lack of self-confidence, or other insecurities. 14,15 These factors are displayed socially in insufficient self-esteem and self-importance, ie, the lack of belief in one's ability, and self-respect, or in other words, a deteriorated "ego" or sense of self. 16,17 Egoism, Childhood, Adolescence, and Power Egoism or narcissism can be a natural part of a normal childhood and early adolescent development. It plays a vital role in building one's emerging but fragile ego, which develops normally having a supportive and healthy home life. It is regarded as necessary educational support to promote self-esteem and group learning experiences. However, the lack of support and educational resources may trigger an abnormal development, leaving critical footprints on the next stage of life, ie, Adolescence. [16][17][18] Adolescence is recognized as a critical stage of development, not only for the individual but for societal survival. During this time, the unique, age-specific neurological development of the brain occurs, and many experience personal anxiety, doubt, shame, depression, guilt, and sorrow, and establish both age-appropriate neurologically and socially beneficial developmental tasks, resulting in a sense of accomplishment. 8,[16][17][18] In addition, through healthy adolescent curiosity, other requirements for abstract thinking, such as critical reflection, perception, observation, intuition, negotiation, cooperation, and reasoning that uses judgment, conceptualization, and generalization in one's thinking and decisions that include the foundation of ethics and morality, and finally empathy, as a strong sense of self-awareness, are tested and learned. The outcome would be autonomy and independence that together with education and experience result in maturity, necessary after 20 years of age if there has been no deterioration in one's ego. 8,17,19 In most people, narcissism stays in childhood. However, for those with affected ego, the risk of narcissistic behavior continues to dominate development into adulthood, becoming part of one's personality. Factors that reportedly cause narcissism to continue beyond childhood vary and are probably a combination of diverse and competing factors, but often affected individuals have had excessively over-indulged and pampering parents, who selfishly convinced their child for being "special" in a bid to build and boost their self-esteem. 14,16,19 They may also come from chronic parental abuse, absence, or trauma, and possibly a genetic component that is dominantly male. 17,19 The outcome between these 2 groups might be different due to which environment they live in but without any intervention, risks the start of an "epidemic of narcissism" within the individual. 8,17,19 This is characterized in adolescents when they fail to understand and appreciate the perspectives of others, showing signs of an emotional and cognitive arrest dating to childhood and early adolescence that limits their development to concrete black and white thinking. They lack a conscience, empathy, guilt, anxiety, or sorrow, which later progress to maintaining a level of persistent arrogance that serves as a cover for their insecurity and a continual search for power to control everyone and everything. 19,20 While they may appear to be "smart" they are not appreciated as being "bright" in considering the opinions or facts of others in decision-making.

Adulthood and the Final Conversion
As adults, they face a myriad of difficult social issues, such as marital conflicts and divorces. They violate the law, have debts, fabricate evidence, and exaggerate and lie about their background and personal achievements and education, all common signs among pathological narcissists. [19][20][21] When challenged, they may rapidly de-escalate into sarcastic and inflated insults meant to intimidate their accusers, an act of exerting power to change the reality. 19 The constant failure in socializing and an unsuccessful adolescent development leads to an inability to perform tasks associated with 2 A Khorram-Manesh and FM Burkle adulthood, triggering character flaws that begin to form the personalities of potential autocrats seeking a greater stage and more power in life across a spectrum of antisocial and narcissistic behaviors, depending on what is needed to perpetuate their own needs and actions, and in which environment they live. [19][20][21] Their actions are manipulative and perceived by many as being "smart"; however, they lack abstract thinking, reflection, awareness, and appreciation for their actions, all developmental tasks they never completed, and consequently are not seen as "bright" or broadminded. They lack accountability and never accept responsibility, blaming others for failures. 19 While often appreciated as fearless, confident, uncompromising, and ruthless when assuming their leadership role, they are incompetent. Failing to govern fairly, substituting shadiness and hypocrisy for the lack of competence, obsessing over power, perpetuating fraud, and gaming the system become their own "theology." 20,21 Core Values in Leadership According to the Social Change Model, the core values in leadership can be divided into 3 categories, and the interaction between their components creates important criteria for good leadership. 22,23 The first value is individual values, which consist of self-consciousness, congruence, and commitment. A good leader should be aware of the beliefs, values, attitudes, and emotions that motivate her/him to act. As these actions involve a leader's thinking, feeling, and behavior, they must be presented with consistency, authenticity, and honesty, along with commitment toward other group members. Group values, the second leadership value, indicate a mutual goal that aims to facilitate the group's ability to engage in collective analysis of data and engagement in planned tasks and actions, representing a common purpose. This needs collaboration, based on mutual trust, recognition of inevitable differences in viewpoint and a need for discussing such differences, and a willingness to hear each other's views and exercise restraint in criticizing the views and actions of others (controversy with civility). Finally, the third leadership quality, citizenship, and change are 2 other basic values for society/community. The former suggests the process of creating a responsible connection between an individual and the collaborative group to the community and society through the leadership development activity. The latter emphasizes being able to adapt to constantly evolving environments and situations while maintaining the core functions of the group. [22][23][24] Some of these values can be learned, and some must be mastered by training for a long period and, in both cases, a normal neuropsychological development is necessary. Individual values, for instance, should be learned and tested long before attending a university program and are an essential requirement for understanding group values. Furthermore, both individual and group values are important factors for acquiring civic responsibility and being prepared for evolving changes. 24,25 Leadership starts in childhood. In many countries, potential leaders can be found in schools, sports teams, academic contests, and sometimes by chance and through an event or incident. 26 Linking the leadership ability to the failure in developing a healthy narcissist, the lack of early investment in educational initiatives and supportive measures, either through family or a school program, is a true limitation to enhancing the individual characteristics of a young leader. These characteristics are personality, values and beliefs, vision and motivation, skills, level and type of experience, previous interactions with others within and external to the workplace, and finally a specific mood and empathy. 23,24 These are essential characteristics that develop from childhood to adolescence and adulthood in a normal growing child, whose narcissism disappears gradually when maturity develops. Any abnormality may result in narcissistic sociopathy and produce leaders that grow to become autocratic leaders in the search for exerting their power, with no empathy for the outcomes. 19,21 Narcissistic Sociopathy in Global Autocratic Leaders The arrested transition of healthy narcissism and the deviation in development in some individuals create leaders with an obsessive demand for Power. 8,17,19 Wars and internal conflicts attribute to unresolved causes, creating a vacuum of leadership, and letting those who control power, rise to leadership. The distrust of the previous government and the severe economic and social outcomes of the war and conflict create opportunities for new "stars" to rise and shine, claiming themselves to be saviors and having solutions for all. 27 A single decision-maker, characterized by Hitler, Mussolini, Stalin, and Tojo, ignited World War II. The end of the Cold War, and the dissolution of the Soviet Union in 1991, strengthened the power of those at the top or gave birth to rising authoritarian regimes, who proved to be heartless, self-serving, vile leaders, pleading for the mass support in a bid to obtain the power, and becoming despots or common criminals, still claiming to be "patriots, after obtaining the power." 8 These incompetent leaders ruled over the world's most vulnerable and lawless countries, often assured tenure by the easy availability of sophisticated weaponry and ready access to eager followers, and the support of another country(ies). Collectively, they all share a psychological framework that differs little from those responsible for World War I, World War II, and the conflicts that plagued the Cold War and post-Cold War eras. Even today, the world is witnessing a plethora of oligarchic autocracies. In 2018, one-third of the global population lived under outright authoritarian regimes. 28,29 A repressive nation can be either a pure autocracy, ruled by 1 dictator, or oligarchies (the power is held by members of an elite segment of society), such as in Russia, China, and the Philippines. From 2017 through 2020, the Trump Administration put the United States on that same track with a corporate elite having a greater influence than "the people." Other autocratic models are military dictatorships in which all citizens must adhere to their respective strict military laws, as seen in Libya, Pakistan, and Burma (Myanmar). 8,28 An additional type of authoritarianism exists, which can be found in the Northern Triangle of Central America. Gang violence in Honduras, Guatemala, and El Salvador has subverted all existing government authority, leaving people starving for law and order or fleeing for a better life in other countries. 29 A vital first step in understanding the wide range of despotic, narcissistic leadership comes with knowledge of an autocrat's development from childhood into adulthood and the recognition of the unique role adolescent growth plays in ensuring either stable adulthood or 1 that is self-serving and oppressive. From an early age, narcissists demonstrate unchangeable beliefs and behaviors that are the absolute antithesis of everything a democracy demands of an individual. Their regard for others in power is the extension of an adolescent obsession with more successful bullies. The consistent pattern of praise and envy for other world despots is remarkably consistent. They share similar character traits, such as an absence of conscience and an unquenchable desire for acclamation. Across the personality spectrum, Russian despot Vladimir Putin seems more Disaster Medicine and Public Health Preparedness sociopathic and less demonstrably narcissistic than Donald Trump. But Mr. Putin's intimidating and disarming silence provides him with powerful and convincing self-importance. The development of autocratic leaders in history reveals that many share severe character disorders that are consistently similar across borders and cultures. 19,20 Science, Biology, and Psychopathy Recent advances in neuropsychiatric research identify brain abnormalities in psychopaths that lead to their predictable behavior. [30][31][32] In addition, general effects in the dorsomedial prefrontal cortex, lateral prefrontal cortex, fronto-insular cortex, and amygdala, and aberrant brain activity in the midbrain and inferior parietal cortex have been identified. 30 Additionally, using magnetic resonance imaging (MRI) scans, it has been shown that the striatum, an area of the forebrain, was 10% bigger in psychopathic people compared with a control group of individuals with low or no psychopathic traits. 31 Striatum coordinates numerous elements of cognition, including motor and action planning, decision-making, motivation, reinforcement, and reward perception. These results enable understanding of the role of biology in antisocial, and psychopathological behavior and may help improve existing theories of behavior, as well as inform policy and treatment options.

Hybrid War and Autocratic Leadership
Hybrid warfare was recognized long before the invasion of Crimea by Russia in 2014. It was, however, highly noted after the conflict between Russia and Ukraine, where Russians use all components of a hybrid war, including "political, diplomatic, economic, and financial warfare, legal (lawfare), as well as socio-cultural efforts, with infrastructure, intelligence, and criminal groups widely used." 27,28,33 The involvement of networks of state and non-state participants with various means of military and militia influences and strategies results in a combination that creates difficulties in predicting the means and strategies associated with an armed conflict. [34][35][36] In addition, hybrid warfare represents multi-domain operations, and asymmetry, where the target of warfighting is not limited to the military staff and includes even civilians by creating political instability, conventional assaulting methods, riots, disinformation, and influencing both social media and electoral outcomes. 35,36 It also targets the infrastructure, hospitals, healthcare workers, energy and water sources, and everything else that can paralyze the life of people. By preventing international health organizations, such as the International Committee of Red Cross and Red Crescent (ICRC), no international observers can report and supervise the outcome of the conflict, paving the way for the negligence of the IHL and GC.
Hybrid wars facilitate the need for autocratic leaders in controlling their power by intimidating and creating chaos. Autocratic leaders such as Saddam Hussein in Iraq, Slobodan Milošević in Serbia, Mohamed Farrah Aidid in Somalia, and the current ruler in Syria Bashar al-Assad all have signs of narcissistic sociopaths and psychopaths, driven to pursue war due to complete failure as leaders during peacetime. These autocrats did not and do not have the ability to ignite a conventional war, but all thrived on creating and maintaining a state of conflict around them, a tyrannical condition as part of their psyche. 19 The Final Words, How Do We Cope With the Situation?
"Starting with the war in Syria, Professor Burkle stated that hybrid warfare was designed for and by sociopathic autocrats." This study presented the psychological developments of individuals with narcissistic and psychopathological disorders and their desire for controlling anyone and anything. It also described the implications of an abnormal progression of these individuals and their desire of grasping the role of leadership and how they benefit from a chaotic environment and the vacuum that appears after internal or international conflicts. Hybrid war is the act of bullying in a larger dimension and perfectly suits narcissistic psychopaths, with no conscience and empathy for the suffering of other people and total disrespect for humanity and humanitarian law. 8,12,13,27,33 The Ukrainian war has changed everything we know about "civilized conflict." Hybrid warfare is purposefully brutal for a reason, to make the invaded nation give up. In hybrid warfare, civilians are a legitimate target from the outset, as are forced deportations, using unnamed criminal groups because they lack a conscience and other warfare such as chemical warfare that was used in Syria by Russia. While the west is locked into conventional warfare rules guided by the ICRC and IHL, they are ignored by those initiating hybrid war. 6,7 There has been constant negligence of international law and erosion of international criminal law in the Ukrainian conflict as well as in other previous conflicts such as the one in Syria. However, this is not only due to the act of Russia and China and the other suspects, but also due to the attitude of Western states, including the United States and the United Kingdom as in the war against Iraq, causing 1 million deaths, war crimes, and torture. The act of double standard is not limited to a few countries. Recently, the United Nations (UN) General Assembly voted 93 to 24 to suspend Russia from the UN Human Rights Council. Fifty-eight nations abstained from the vote. The resolution accused Russia of "gross and systematic violations and abuses of human rights" in Ukraine. While many states abstained, several Western allies such as India and South Africa voted against it. This is of course due to geopolitical reasons, the dependence on Russian gas and oil, but also the fact that many states are not happy with the Western attitude of using international law only when it serves their interest and objecting to it when it is against their interest. This is an attitude that erodes the legitimation of international and especially international criminal law. These laws will only apply if Western states agree to apply universal standards. 37 Although the United States has requested the UN to undertake an independent investigation regarding the crimes committed in Ukraine, it is interesting to know that the United States itself has long opposed the International Criminal Court (ICC), which has been ratified by 123 nations, but not the United States, Russia, or Ukraine. In 2020, President Trump went so far as to sanction senior ICC figures involved in investigating possible US war crimes in Afghanistan. While President Biden removed these sanctions, he still refuses to submit to the authority of the ICC. This presents the double standards in international conflicts. 38 There are some limitations in using ICC to put responsible persons on trial. First, the investigation will be limited to war crimes, and the crime of aggression is not covered due to the weak legislation and the fact that many states do not want to submit themselves under any kind of international jurisdiction. Second, Although the recognition of the ICC is 1 step forward, international criminal justice is currently overestimated. The record of the ICC is poor, mainly because a very long time is needed to gather the information that proves war crimes have been committed. Additionally, they need to reach the highest ranks, which is almost impossible as proven in other conflicts with attacks on civilians, such as in 4 A Khorram-Manesh and FM Burkle Grozny, Chechnya, and Aleppo in Syria. Unfortunately, international law, especially the so-called international humanitarian law, is considered to allow too much. The ongoing double standards should be stopped and replaced by a system with universal standards, and a special tribunal covering war crimes, as well as the crime of aggression. 37,38 Conflicts and wars are disasters caused by man. While contemporary medical thinking is reluctant to accept the neuroscience behind understanding a leader's decisions and behaviors, a more multidisciplinary understanding of the behaviors, all of which are globally crucial to mankind's future, must be incorporated.