It's the lack of an active vision that creates problems not the hierarchical or flat structure of the organization.
For example a democratic process can be used to maintain an organizations active vision including resolving disruptive people and processes.
The idea of a democratic process presupposes an institution, which includes explicit divisions of power, which is independent of the individuals taking part.
It is still a hierarchy as someone will hold the power. It is an explicit hierarchy because those powers are enumerated. That the process of replacement is democratic is slightly besides the point (though not entirely, as it prevents all-or-nothing power acquisition).
Whereas a loose, "flat" organisation with no differentiation between the rights, responsibilities and power of members is utterly vulnerable to the first sociopath who happens upon it. Such a person will wind up with an informal dictatorship and everyone else will be stuffed.
I agree that a loose "flat" organization is prone to serious problems :)
This is an absolutely classic rule of managing any organisation where competing priorities must be settled.
Chains of command have a very high cost, but they can ameliorate internal politicking and remove uncertainty about what, if anything, has been decided.
However, decision making power must come with accountability for the decisions, or it will NOT turn out well.
A purely flat organisation will wind up with de facto bosses, minus any institutional constraints on their activities and minus any accountability. If you're dealing with a sociopath the damage they can wreak will be magnified by the lack of structure to constrain their power.