‘The Brain Dead Megaphone’ – Dr John Hillery’s first address as CPsychI President

‘The Brain Dead Megaphone’ – Post Truth Society and the Psychiatrists’ Role

I write this piece in the shadow of the news of the death of Dermot Walsh. Dermot had a profound effect on any of us who interacted with him in the course of our development as Psychiatrists. We may not have always agreed with him but we always came away with food for thought and reflection. He was an international figure but also a compassionate and simple man. My first memories of any campaigning for the establishment of an Irish College of Psychiatrists involve Dermot. I was sceptical of the need for separation from the Royal College. Like many I doubted the viability of a separate organisation. The idea seemed to me then to stem from a faux nationalism that would be out of place in a scientific endeavour. Changes in the Irish Medical Regulatory framework and the British Medical Training system rendered such reservations redundant. There had to be an Irish College to oversee postgraduate training and competence assurance. Luckily people such as Dermot had already planted the seed. The College is now nearly ten years old. Thanks to the work put in by my predecessors and the members and staff who worked with them it is in a good position to deliver on its core mission of training and competence assurance.

Leaving aside the legislative requirements that mandate the need for an Irish College I believe that Dermot and people like him saw the need for a College of Psychiatry to be a standard bearer for the critical discussion and promotion of evidence based methods in Psychiatric Service Delivery in Ireland. Irish officialdom has a distrust of and disregard for foreign agents that would try and direct national policy or legislation. Thus an Irish College is vital to ensure that those with the power are constantly prompted to ensure that people with mental illness in Ireland get access to the evidence based treatments they deserve, supplied by appropriately trained medical specialists.

The need for such standards of knowledge and advocacy based on it has never been greater. We may look to America with trepidation, awe and even amusement at the “Post Truth Society” but Ireland is not immune to this trend. George Saunders, in his prescient essay ‘The Brain Dead Megaphone’, focuses on the worldwide impact of the loud and the vacuous drowning out the quiet and the knowledgeable. He asks us to picture a social event where people are enjoying stimulating discussions on subjects those present have some knowledge of, when a man with a megaphone enters the room. Though the man knows little he has opinions and the megaphone. Soon everyone present is being influenced in some way by the man with the megaphone and the facts no longer matter. Saunders hypothesises that his scenario represents the media and, indeed, society today. His call for us all to regain responsibility in ensuring that there are rich fact-based dialogues on important subjects is echoed by Michael Marmot in the Lancet recently. In a piece subtitled ‘Post – truth and science’ Marmot, of the UCL Institute of Health Equity, issues a rallying cry to scientists and those who critically use scientific fact in their everyday lives. Pointing out that an IPSOS MORI “Veracity Poll” of 2016 suggests that the public trust of Doctors is the highest and far above public trust of politicians, government ministers and journalists he reminds us of our responsibilities. A similar poll in Ireland reveals similar trends.

Such trust comes with responsibilities. Marmot writes: “If we want the perceived dishonesty of the Trumps of this world and the Brexiteers to pass then scientists and health professionals, for whom truth is central, have to be even more diligent”. Our responsibilities as doctors include being leaders in ensuring that, as individuals, we are up to date in the knowledge we use in treating patients; in guaranteeing that the next generation of psychiatrists are trained to critically assess and make use of evidence based information; and in advocating for evidence based treatments and services for our patients and people with mental illness in general. The most powerful way to do all these is in a united, collegiate manner. Thanks to the work already done we have a functioning recognised body prompting and supporting these activities.

The College of Psychiatrists of Ireland has become the body we can all look to for promotion and support of fact based leadership as regards best practice in Psychiatry. Now the volume of and the rate of dissemination of opinion masquerading as fact makes such leadership more important than ever. As a young college our main resource is ourselves, the membership. This is a strength but, as all members are already very busy, a potential weakness also. Irish Psychiatry needs to be ready to proactively and reactively deal with opinion masquerading as fact. I hope that in the next few years we as a College can increase the number of agreed College Positions and Policies. This is especially important as the government revises the Mental Health Act and as a hired consultancy revises A Vision for Change. To do this however we need all members to play a part. This can happen through the Faculties but can also be done by individual members proposing documents and working with College staff on their development. Please let me know what your priorities are in this regard. I look forward to working with all my fellow members of College over the next three years.

I will close with a quote that’s decades old but more pertinent than ever. Senator Daniel Moynihan of the USA said “Everyone’s entitled to their own opinion, but not their own facts.” The facts and ensuring their critical appraisal, dissemination and appropriate use is what a College is for.

Dr John Hillery

President of the College of Psychiatrists of Ireland