Authenticated user menu

10 June 2012
Total views

Parrhesia: Free Speech in Medical Leadership

Parrhesia? No, I hadn't heard of it either. But then, a few years ago whilst undertaking research for what was to become my PhD thesis, I became deeply interested in the writings of French philosopher Michel Foucault. One of Foucault's abiding passions was a scrutiny of the basis of perceived 'power' in traditional medical discourse. The scope of his work extended into a detailed analysis of, amongst other things, the origin of notions of mental illness as a social convenience, and the ways in which physicians and patients act out a particular relationship founded more upon artificial ideas about deference and symbolism than anything real or meaningful. All interesting stuff in relation to leadership - but I digress.

Parrhesia, derived from the Greek concept of "to speak freely" or "to speak everything", underpinned the courts of Athens in Classical times. It was also a privilege enjoyed within theatrical circles of the time; indeed, it was only within the judicial or thespian circles of Classical Greek life that comment could be made with absolute honesty without any risk of censure or worse. Interestingly, though, only those fulfilling certain criteria were allowed this absolute feedom of speech even within those two particular environments. See what you think of those criteria:

1. The parrhesiast (what a fantastic word!) had to be recognised as one holding a credible relationship to the truth:

2. They had to serve as a critic of themselves or popular culture;

3. They had to feel it was their moral or cultural imperative to speak the absolute truth on an issue without censure or punishment. (1).

Foucault seized upon this concept of parrhesia as being as relevant to 20th century (he died in the 1980's) clinical discourse as it was to the ancient Athenians. Writing in Fearless Speech, he observes:

"...parrhesia is a verbal activity where the speaker expresses a personal relationship to truth, because they recognise truth-telling as a duty to improve or help other people. In parrhesia, the speaker uses freedom and chooses frankness instead of persuasion, truth instead of falsehood or silence, criticism instead of flattery, and moral duty instead of self-interest." (2)

Fascinating stuff, and space here does not do the notion of parrhesia the attention it deserves. Of particular interest to me is how closely his words reflect the ethos of the current Medical Leadership Competency Framework. We are all, in hoping to be leaders in healthcare, hoping too to be parrhesiastic in our practice. And in that we share a link with Aristophanes.


1. Sluiter I, Rosen RM. 2004. Free Speech in Classical Antiquity. Brill Books: Leiden.

2. Foucault M. [posthumous] 2001. Fearless Speech. Semiotext: Los Angeles.

 or  Register to add a comment

About the author

Darren Kilroy's picture

Darren Kilroy

Darren Kilroy FCEM M.Ed. Ph.D. is a Consultant in Emergency Medicine in Cheshire, and Director for Network Leadership and Development in Unscheduled Care. He is also Hon. Senior Lecturer in Emergency Care at Manchester Metropolitan University, and Clinical Lead for Unscheduled Care at NHS Stockport. His main areas of interest are the challenges of clinical and managerial engagement around emergent clinical commissioning models, and the role of clinical leadership within transformational change.


Array ( [0] => sitewide [1] => advert_external_leaderboard [2] => not_front_desktop [3] => advert_external_wideskyscraper [4] => comments [5] => comments_login_prompt [6] => jobs_content_pages [7] => node-social-accelerators [8] => node_blog [9] => related_content [10] => advert_internal_desktop )