The Arab Spring was a watershed in Arab history, which gave young protesters the impetus to challenge established and entrenched dictatorial regimes for the first time and to demand democracy. This unique book reviews specialist literature and provides a profile of the personality disorder of narcissism displayed by five leaders - Hosni Mubarak, Muammar Qaddafi, Zine El Abidine Ben Ali, Ali Abdullah Saleh, and Bashar al-Assad - together with the related syndromes of paranoia, hysteria, and sociopathy. The book argues that the responses of these leaders to the challenges they faced indicate that they were psychologically incapable of facing reality, and indeed displayed pathological symptoms in clinging fanatically to power in the face of revolt. Madmen at the Helm considers each of the five leaders in turn, examining their behavior during the upheavals as expressed in their public statements, speeches, interviews, and courses of action. Thus, the book identifies patterns and similarities of behavior that serve to prove that the five 'stony-faced old men in power' displayed specific pathological personality types in their responses to the political and cultural circumstances in which they were operating. A postscript to the book widens this context by identifying two cases of narcissism in contemporary American politics: George W. Bush and Sarah Palin. This highly topical, accessible, and relevant book provides a psycho-historical insight into the actions and responses of the deposed dictators, viewed from a unique clinical psychological perspective.