In rhetoric, parrhesia is a figure of speech described as: “to speak candidly or to ask forgiveness for so speaking”. This Ancient Greek word has three different forms, as related by Michel Foucault: parrhesia, is a noun, meaning “free speech” ;. The first of these chapters attends to the meaning and the evolution of the term “ parrhesia.” Foucault characterizes parrhesia as “a verbal. Abstract. Foucault’s discussions of parrhesia provide fertile ground for raising a number of classical and pertinent issues in political theory related to critique.

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In his six lectures published under the title, Fearless SpeechMichel Foucault developed the theme of free speech and its relation to frankness, truth-telling, criticism, and duty. Derived from the ancient Greek word parrhesiaFoucault’s analysis of free speech is relevant to the mentoring of medical students.

This is especially true given the educational and social need to transform future physicians into able citizens who practice a fearless freedom of expression on behalf of their patients, the public, the medical profession, and themselves in the public and political arena. In this paper, we argue that Foucault’s understanding of free speech, or parrhesiashould be read as an ethical response to the American Medical Association’s recent educational effort, Initiative to Transform Medical Education ITME: Recommendations for change in the system of medical education In this document, the American Medical Association identifies gaps in medical education, emphasizing the need to enhance health system safety and quality, to improve education in training institutions, and to address the inadequacy of physician preparedness in new content areas.

These gaps, and their relationship to the ITME goal of promoting excellence in patient care by implementing reform in the US system of medical education, call for a serious consideration and use of Foucault’s parrhesia in the way that medical students are trained and mentored.

Recommendations for change in the system of medical education. The explicit goal of this document is to:. Promote excellence in patient care by implementing reform in the medical education and training continuum, from pre-medical preparation and medical school admissions through continuing physician professional development. More specifically, foucahlt, the ITME points to a growing gap between the emerging demands of clinical practice, on the one hand, and the ability of the US system of medical education to meet these demands, on the other.

The two main proposed outcomes of the ITME initiative are:. The creation of a system of medical education that better equips young physicians with the knowledge, skills, attitudes, and values necessary to provide quality medical care and the ability to continually update their learning; and the availability of appropriate resources, including funding, faculty, clinical sites, and technology to support needed changes in medical education across the continuum.

The report then makes ten recommendations in support fkucault these outcomes. This essay will respond in detail to three of these recommendations Nos.

They are as follows:. These three recommendations are, in themselves, a tall order. How, we might ask, can those who teach medicine best ensure that they are apt role models, that they demonstrably value and reward meaningful participation in the educational process, and more significantly, ensure the transfer not focuault of clinical knowledge and skills, but foremost, the attitudes, behaviors, and foucajlt appropriate to a caring aprrhesia responsible physician?

With recommendations such as these, clearly parrnesia AMA is gesturing to a kind of medical education that reaches beyond parrhesiaa instruction of knowledge, skills, and information. Those who teach medicine therefore have a dual responsibility to society: In other words, medical faculty should teach students not parrhesai to be capable practitioners of their art, but also to be thoughtful, questioning professionals in regard to the society around them.

How shall we best address these ITME challenges? This question is all the more exigent because the physician stands at the crossroads of power, knowledge, and technology. And in today’s society, knowledge and technology are scarcely separable from power-relations and their effects [ 2 ]. Here, the earlier work of Foucault is helpful in understanding power. For him, power is not a “thing,” it is not a possession that can pxrrhesia wielded and deployed; instead, we find ourselves within a scientific and technological power matrix, as nodes or circuits in the perpetual negotiation of power, parrhesiaa, and knowledge.

In this sense, medical knowledge is a form of what Foucault parrheisa “biopower,” the power over the life of the biological body. Foucault notes a foucult of medical techniques beginning in the eighteenth century, an important historical development because medical knowledge was able to avert some of the imminent risks of disease and death.

This made medicine a social and political concern. On the one hand, fojcault control over life was effected at the level of the individual through what Foucault calls “anatomo-politics”while on the other, biopower became concerned with the administration and regulation of biological bodies insofar as they comprise populations through what Foucault calls “bio-politics”.

The goal of biopolitics was — and still is — “to rationalize the problems presented to governmental practice by the phenomena characteristic of a group of living human beings constituted as a population: In sum, medical students must learn to practice parrhesiathey must speak fearlessly. This does not exactly mean that they toucault speak without fear; rather, it means that they will learn to have the courage to speak under fearful circumstances — to address and to critique those institutions or foucauot who control more power, knowledge, and technology than the one who speaks.


It means “speaking truth to power,” as Foucault has said. Such an attitude, behavior, or value cannot exactly be “taught” as a skill or as piece of positive knowledge.

It calls for an apprenticeship by mentors who will foster such an ethos in their students, who demonstrate parrhesia themselves, and who actively encourage new discourses in their teaching, their research, and beyond.

Parrhesia means free speech, but it is more than this: It is to speak in a situation in which one’s speech carries a certain risk to one’s reputation or even to one’s life. When you accept the parrhesiastic game in which your own life is exposed, you are taking up a specific relationship to yourself: Parrhesia is a form of criticism, either towards another or towards oneself, but always in a situation where the speaker or confessor is in a position of inferiority with respect to the interlocutor.

The parrhesiastes is always less powerful than the one with whom he speaks. We shall refer to this definition throughout the essay. However, in a nutshell we might say that, in order for speech to qualify as parrhesiacertain conditions must be met — speaking out in a social situation that places the speaker in danger or at risk because there is an imbalance of power or status between the speaker and his or her audience.

Moreover, in the parrhesiastic situation, the audience does not want to hear the speech because it contains a deep criticism or critique of the current order of things, for foucahlt those in power the audience are somehow parrhesia. It forces those in power parrhesiw account for themselves and their actions. It therefore takes great courage to speak out, and yet despite the risks, the speaker experiences a social and political duty to speak all the same. The concept of parrhesia helps us to contextualize the “attitudes,” “behaviors,” and “values” mentioned in the ITME recommendations above.

As Foucault notes, the parrhesiastes — the one who speaks with parrhesia — is engaged in an ethical decision.


Parrhesia is a self-relation. For this reason, parrhesia can also be understood as the kind of speech I have with myself when I plainly tell parrhesiw things I do not really want to hear, when I am faced with an agonizing decision, and I find the courage to face my fears, my uncertainty, and to ask myself whether I am really speaking or acting ethically. I risk my self in order to be myself, authentically [ 6 ].

We might rightly ask how we know with certainty that the one who speaks with parrhesia parrnesia a truth-teller. How do we know the he or she possesses the truth? The modern scientist most of our readers will logically demand some sort of “evidence” — something that will be verifiable according to the wisdom of the scientific method.

This led Foucault to suggest: The self-relation of the parrhesiastes is, after all, first an ethical and prrhesia relation, not explicitly a relation of knowledge.

But modern knowledge is a relatively recent invention, and Foucault takes pains to explain modern epistemology as the gradual ascendency of mental evidence beginning roughly with Descartes in the seventeenth century. According to Descartes, “evidence” is given to consciousness without any possible doubt when it is “clear and distinct” omne illus verum est, quod clare et distincte percipitur. Since Descartes, philosophical and scientific thought the two were not yet separate asks the following question, according to Foucault: The answer, if we rely on our modern epistemological framework, is the following: The modern presumption patrhesia is that true knowledge is mental, that “evidence” is pure — and that true knowledge means disinterested scientific research, ostensibly free from the body, from the emotions, and from any other “special interests,” or — to use another modern word — from the myriad stakeholders in the production of “truth.

Foucault’s critical response to our “modern epistemological framework” is twofold. First, he exposes the self-deceptive error of modern epistemology, that larrhesia could be disinterested and free. And second, he suggests that the concept of parrhesia would allow us to adopt and adapt an ancient Greek wisdom that points to the ethical and spiritual dimensions of the pursuit of knowledge, thus proposing a model that would acknowledge the ruses of modern epistemology while allowing us to move beyond them.

In the case of medicine, certainly in the US and also in large parts of the present-day world, this is obvious when we consider the influence of financial rewards, our careers and promotion, government agencies that regulate and monitor and sponsor knowledge-production and knowledge-transfer, the myriad interests of public policy decision-makers, the pharmaceutical industry, the insurance industry, various government lobbies, the legal-juridical complex, the convergence of research and business interests — and the list goes on and on.

Suffice it to say that this is only the barest allusion to some ways that power and knowledge are imbricated in the scientific enterprise, pointing beyond the medical continuum to the real gatekeepers of scientific knowledge or “truth. Given this nexus of power, knowledge, and technology, it seems only just that we should find ways to challenge those who wield such power, to expose corruption, and to speak out. Padrhesia than presume a modern epistemological framework, and act as if we could speak disinterestedly in the name of a true knowledge that would itself be free from the vagaries of power, parrhesia would be a kind of speech that acknowledges this power and wrestles with it.


The parrhesiastes speaks from within the situation, and does not pretend to occupy a space that is epistemologically neutral and free from constraint. The ethical and spiritual self-relation of the parrhesiastes thus represents a compelling critique of the modern epistemological framework.

And in a fuocault ruled by modern epistemology, such speech itself must be parrhesiastic! Foucault returns us to the ancient Greeks not out of some philosophical nostalgia; nor does he wish for a wholesale return to a time long gone. Rather, taking parrhesia seriously raises a number of difficult questions for our own ways of knowing.

Can an ethical and foucauot self-relation still speak to us? What is parrhesia or free speech if it is an ethical and spiritual relation, an agonistic relation? Against the “modern epistemological framework” of philosophy and science, Foucault argues that spirituality is “the search, the practice, and experience through which the pqrrhesia carries out the necessary transformations on himself in order to have access to the truth” [ 7 ].

Here we must stress the transformation of the individual, which might also be conceived as a kind of conversion. This is a radical reversal of modern epistemology.

In modern epistemology, we are presumed to have access to the truth; here, in contradistinction, in order to have access to the truth, one must struggle to stand in the correct spiritual and ethical relation, one must be transformed. It is not enough to have mental evidence, but the condition of possibility for access to true knowledge is the fruit of a kind of spiritual and ethical apprenticeship.

This apprenticeship prepares the way for knowledge, and allows the individual to transform evidence and information into meaningful knowledge and truth. In short, I think we can say that in and of itself an act of knowledge could never give access to the truth unless it was prepared, parrhesai, doubled, and completed by a certain transformation of the subject” [ 7 ].

Medical schools, simply put, are places where teachers and students engage in clinical work and research. Patients must be cared for, students must be taught, faculty must publish usuallyand young, competent physicians, who score well on their licensing examinations and capture seats in “outstanding” residency training programs, must be produced.

Producing such a fine product a premiere medical studentin addition to quality research, allows a medical school to more effectively compete against other institutions for grant monies and well-recognized faculty candidates through an enhanced reputation.

Increasingly, faculty members are concerned that the American system of medical education must now also teach due diligence, and must develop an adequate response if we hope to graduate self-sufficient practitioners at least in their initial practice of medicine [ 910 ].

Furthermore, in the US, students enter medical practice with a burden of debt that causes them so much anxiety that they are often directed toward specialties or practices that are more lucrative, even though as students they may have preferred to do something else [ 11 ].

This is neither good for the physician nor for the public at large. US medical education has been transformed over the past four decades by public discourses initiated by the legal community, government, insurance industry, pharmaceutical firms, patients, and even medical faculties themselves. The power wielded by the media, government, corporations, patient advocacy groups, etc.

Parrhesia – Wikipedia

These transformations over recent decades have produced a truth about US medical education that differs from the truth of 40 years ago. The ITME acknowledges some of the challenges wrought by these transformations.

But how should we respond? Medical practice involves power who hires you, who pays you, who sues you, which hospital gives you privileges parrhsia to what extentknowledge board certification, locating a practice, how to administer a practice, how patients are billed, how procedures are doneand technology equipment, procedures, laboratory testing, and DNA counseling.

Foucault is useful fouxault a discussion of medical education because he demonstrates that current practices — while they appear to be “neutral” or obviously “true” to us — nevertheless rely on social, historical, and political contingencies. Foucault promised a “history of the present” in his work. In other words, when we understand how things came to be as they are, now, we recognize that they might have been parhesia this is empowering, because foufault allows us to imagine how things could be otherwise, how they could be transformed, in the future.

The political and social processes by which Western European societies were put in order are not very apparent, have been forgotten, or have become habitual. They are part of our most familiar landscape, and we don’t perceive them anymore.