Former Head of the Department of Psychiatry, University of Oxford, Guy Goodwin, is stepping down as President of the European College of Neuropsychopharmacology (ECNP). This pan-European scientific association was founded in 1987 to encourage innovative research across the neurosciences and to translate new knowledge on fundamental disease mechanisms into new medicines and clinical applications.
‘The 2016 congress in Vienna was a heartening occasion. It is a particular pleasure that ECNP is able to give such extensive access to young people. Moral support and advice can also be useful. For example, if you want to succeed as a clinical scientist, good luck. It is a long hard road to train as a clinician or scientist, to identify what interests you in research, to get the necessary training in the right environment and then to achieve some originality and independence in what you discover. We hope the collegial atmosphere of ECNP will help you. If you are successful, you may appropriately be asked your public opinion in difficult areas where research and practice do not necessarily align or where research findings are at variance with the current consensus. The academic tradition is to try and give an honest and balanced appraisal. If it is a choice between finely balanced benefits and risks, not everyone will agree but they should be able to agree why not.
There is an alternative route to being heard in public debate. It is to be a controversialist, nihilist or iconoclast. Training for this role is ill-defined and I hope ECNP will not assist you, but it will not be so demanding of ability. The path itself may grow out of disappointments along a more conventional route and/or be a consequence of one’s unco-operative personality; if the latter, you have been born well equipped and less training will be required. For those needing advice, read on.
‘First, you will need to be able to claim to be an expert. Unfortunately this usually requires some form of third-party validation, but is absolutely essential because your ideas have to seem more credible than those someone might tell you in a bar. There are some useful strategies. For example, you can cultivate a well-placed journalist who likes or, better, needs your story. The journalist will then almost certainly describe you as a world expert, because you are their only authority: they have a strong vested interest in over-stating your importance. You may be lucky enough to find an accommodating employer who allows you a title that sounds great too, or you can invent your own organisation (see below). Remember to repeat and preferably exaggerate your status and expertise before you say anything.
‘Second, choose an area of medicine or science that the press will be interested in. The bad effects of drugs or other treatments provide a perfect focus. Journalists want dramatic stories so they deal in wonder drugs and killer drugs. Find your killer drugs. To find them choose a disease with an occasional really bad outcome (death by suicide, for example). This means that treatment effects are confounded. In other words, if a drug is usually given for a disease that kills, it is easy to claim that the drug not the disease did the dirty work.
‘Third, never knowingly understate your conclusions. It is essential that you make outrageous claims. Only squares are interested in balance. Consider systematically lying; big lies are best. In any case always simply repeat what you have first said. The more often you repeat something the more likely you, and an audience will believe it. Never enter into honest debate, but always claim that a fair debate is all you are looking for. Try to get an academic expert to debate with you. The debate format immediately gives you equal status. This is very helpful. Plus the expert will seem less certain than you. Wipe the floor with him/her.
‘If you find yourself in debate with someone who seems to be threatening your credibility, do not hesitate to attack their integrity. This is often easy if the individual has worked with industry. It does not matter how trivial their contact. Demand to know whether they have ever accepted money from a company. It is ideal if they have: you are liberated to imply that nothing the person says is anything more than drug company propaganda. Do not worry if the expert has put all the money into a research fund or just accepted air fares to save his department money. Non-expert observers will not understand the distinction. All that matters is that you can claim a conflict of interest. Remember you do not have one (and see below).
‘Fourth, write a book. Do not worry if you find that there are five identical books claiming to have discovered that psychiatry kills people, or does more harm than good or is fraudulent. You are bound to be able to find a new angle, and even if you cannot, do not be put off. Just repeat what the other books say (in your own words of course – plagiarism is best avoided).
‘You will need a publisher. You may be disappointed if you are turned down by a responsible publisher. Do not worry. You will be bound to find a publisher with a personality a bit like yours. When your book is published, get your publisher to maximise the publicity. Never acknowledge that talking about your book is a conflict of interest. Remember, you are always in the right and so cannot have a conflict of interest, ever.
‘You may find that your book and your opinions generally are unpopular with people who claim to know more than you do. This is very helpful. You can henceforth claim to be a victim. As a victim, do not fail to bully and harass people who do not agree with you. Social media are made for this purpose. Remember it is always the other person’s own fault when you are obliged to behave badly. With the status of victim, it will be natural to be paranoid. You must embrace this: it will be very helpful to hold your views with delusional conviction.
‘It is particular useful to be a victim in public sector employment. This may enable you to gain undeserved promotion: remember the organisation will be afraid of you and is spending other people’s money. Even better, if your delusional system is compatible with a totalitarian political position, it may actually be shared by your employers. Remember, indifference to the suffering of real individuals tends to be a position shared by extreme left and right. As a victim, your suffering is of course more valid and much more important.
‘Finally, avoid seeing and treating patients. You will find it much easier to lie and exaggerate if you are untroubled by worries about how actual patients are living their lives.
‘There are a few problems that may crop up. You will find that you are not alone in developing your career. There will be a small number of other people making exactly the same claims. It may be worth your while making friends with these people, difficult as that may be. Of course, it will be irritating to share the limelight that you alone deserve. But you can then endorse each other’s work. Indeed, there may be enough of you to form an organisation that can assume a very impressive name: the more grandiose the better. Call a press conference and announce yourselves.
‘You will not enjoy the respect of your peers, the majority of the population will be indifferent, but you will find a small but adoring group of supporters who will connect with you by social media. You will have deserved them.
‘These recommendations, of course, bear no relation to the actual careers of anyone dead, alive or, hopefully future. Life is a serious comedy so, keep smiling, and join ECNP if you have not already done so!’