Tuesday, January 10, 2012

Ve Have Vays of Making You Talk, Part VI: Post Hoc Reasoning

Reproduced from

In Part I of this post, I discussed why family members hate to discuss their chronic repetitive ongoing interpersonal difficulties with each other (metacommunication), and the problems that usually ensue whenever they try. 

I discussed the most common avoidance strategy - merely changing the subject (#1) - and suggested effective countermoves to keep a constructive conversation on track. In Part II, I discussed strategies #2 and #3, nitpicking and accusations of overgeneralizing respectively. In Part III, I discussed strategy #4, blame shifting. In Part IV, strategy #5, fatalism.

This post is the second in a series about strategy #6, the use of irrational arguments.  Descriptions of this strategy have been subdivided into several posts because, in order to counter irrational arguments, one first has to recognize them.  I will hold off describing strategies to counter the irrational arguments until after I have describe some of the most common types.

Irrational arguments are used in metacommunication to throw other people. The other individuals either becomes confused about, or unsure of the validity of, any point they are trying to make or question they are trying to ask.  Fallacious arguments are also frequently used to avoid divulging an individual's real motives for taking or having taken certain actions. 

The fallacy I would like to discuss in this post is post hoc ergo propter hoc, which literally translated means "after this, therefore because of this." Under this fallacy, two events that occur in sequence are merely assumed to be causally related. That is, if event B follows event A, then an assumption is made that A caused B, even though many other environmental events were also going on during the time between A and B that could have caused B, either individually or in some combination.

This sort of fallacy can be funny when it is obvious but difficult to detect when subtle. No one would believe a doctor who claims that headaches are caused by a deficiency in the body of aspirin, but the debate rages on over whether the effects on assailants of por­nographic movies caused them to become rapists.

I frequently see this fallacy used in arguments made by the anti-psychiatry crowd.  If some psychiatric symptom developed by a patient occurred after he or she either started or discontinued a drug, they argue that it simply must have been caused by the medication.  Well, sometimes it is, but often it is not.  The further removed in time from when the medication was started or discontinued, the less likely it becomes that the drug had anything to do with the symptom. 

There are a very limited number of drug-induced symptoms that, once started, never go away, and those usually involve a situation in which a drug actually grossly damaged an organ.  Some dyes used in X-ray procedures, for example, may physically damage the kidneys. Tardive dyskinesia, a long-term neurological problem in the central nervous system caused by antipsychotic medication, is one obvious exception.

Withdrawal symptoms from addictive drugs almost always go away after a relatively short period of time.

With patients in psychotherapy, the post hoc fallacy is most frequently seen with during conjoint marital or family sessions. When spotted, such a fallacy may reveal the presence of a family myth.  A family myth is a false belief that assists family members in suppressing those thoughts, feelings, preferences, or behavior deemed to be unacceptable and in allowing one or more family members to continue playing a spe­cific role. The myth may be believed by an individual, a sub­system of the family, or the entire family.

Family myths may take the form of a causal explanation of a family member's be­havior that is not the true explanation. In order to be believ­able, the myth often makes use of the post hoc ergo propter hoc fallacy. In such a myth, the belief in a causal connection is based solely on a sequence of events that takes place in a certain period of of time. If the behavior to be explained begins after a certain event, the behavior is blamed on the event. As with other mechanisms used by people who are attempting to hide their true feelings and beliefs, the proposed cause often re­veals clues to the real cause, even though the proposed cause is meant to be a smokescreen.

One example occurred in a family being seen under duress from a probation officer. A young teenager was caught shoplifting. He lived with his father and his siblings. The mother ­had not only divorced the father but abandoned the family, entirely abdicating any family responsibility in order to pursue a career. The father could rarely spend time with the boy because the firm that he worked for was demanding more and more overtime. The father ­routinely worked fourteen-hour days; he expressed disappointment· that the boy could not take better care of himself without supervision.

The post hoc fallacy was expressed in the session following an incident in which the son picked a fight with another boy who was twice his size. The father theorized that the son had engaged in this rather dangerous activity because he had not had a good night's sleep the night before the inci­dent - and was therefore overly irritable.

This seemed to me a rather odd explanation. When provoked, overly irritable people will sometimes unthinkingly do or say things that they other­wise might keep to themselves, but they seldom go out looking for trouble.

The father appeared to be attempting to veer away from any explanation of the boy's odd behavior that might involve family dynamics, but he unwittingly revealed something about himself. It was he, the father, not the son, who was irritable from lack of sleep.

I later guessed that the boy's acting-out behavior was a feeble attempt to force the father, who was utterly ex­hausted from working so much, to work less. The probation officer had in fact required the father to be at home more in order to supervise the misbehav­ing youngster. The boy was also bidding for more attention, as many therapists would theorize, but I believed that he was genuinely concerned about his father’s mental health.

When I suggested to the father that the boy was, at great per­sonal sacrifice, attempting to indirectly demonstrate his concern by forcing the father to insist on more time off, the father never really bought it. However, soon Dad was spending more time home, and the patient stopped acting out. No causal connection between my intervention and the boy’s subsequent im­provement was ever established. 


  1. "I frequently see this fallacy used in arguments made by the anti-psychiatry crowd. If some psychiatric symptom developed by a patient occurred after he or she either started or discontinued a drug, they argue that it simply must have been caused by the medication. Well, sometimes it is, but often it is not. The further removed in time from when the medication was started or discontinued, the less likely it becomes that the drug had anything to do with the symptom."

    Dr. Allen, as an aside, you and your colleagues are as addicted to using the "antipsychiatry" argument as I am to caffeine. Don't you think that is kind of getting old?

    As one who successfully tapered off of 4 meds, I agree that you can't blame everything on withdrawal. At the same time, the issue has been greatly minimized in your literature and frankly, I think you and your colleagues greatly underestimate the problem. Hey, alot easier to blame it on the label, right?

    I am curious, when you try to determine whether something is med withdrawal related or due to other issues, do you also investigate physical possibilities and suggest that someone for example visit their primary care doctor for further evaluation?

    By the way, speaking of long term effects, I developed tinnitus as the result of taking Wellbutrin and it has not gone away. I took my last dose a few years ago.


    1. AA,

      You are correct that many psychiatrists minimize withdrawal symptoms, so we are in agreement. Really, how much can anyone really cover in the 5 to 10 minute visit that has become the standard for some of my more incompetent and/or dishonest fellow psychiatrists.

      I can assure you that I do not practice that way, and that I look for any and all physical/medical, psychological, or social causes that might account for my patients' clinical presentation. I order labs and refer to internists and endocrinologists whenever I think it is important.

      Tinnitus has been reported as a side effect of Wellbutrin and several other psychiatric and medical drugs (aspirin being one of the worst offenders), and that indeed is something that can be very difficult to get rid of.

  2. Thanks Dr. Allen, I greatly appreciate your response.