Five Days of Fallacies: Week 2, Complex Question | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Five Days of Fallacies: Week 2, Complex Question

Five Days of Fallacies: Week 1 here, Week 3 here. I am discussing some common mistakes we humans make in reasoning, in the hope that you can 1) Understand what they are 2) Recognize them when others speak 3) Recognize them when you think this way 4) Attempt to correct your thinking on old, current and future ideas.
The Complex Question Fallacy is in the family of Fallacies of Presumption. It makes assumptions, thereby defining the conversation and the result of the outcome, when asking a question.
An easy example of this is seen here: "When are you going to admit that you lied?" You cannot say "Right now" because that is an admittance of lying. If you say "Never!" you uphold the assumption that you lied, and that you are just not admitting it. Lose lose.
How does this show up in the clinic?Often from patients who are unknowingly setting you up. "How long does this sort of disabling back pain last?" Well if you answer this question quickly, you are affirming the disabling nature of the pain, whether you think you are or not. Even if you said "oh, most people have resumed their normal activities by 4 weeks" thinking that you have put a positive prognosis on the issue, you missed the opportunity to discuss that big fat qualifier in the statement... "disabling." The patient's perspective should be addressed and concerns explored. Perhaps there is more you could gain from having them explain the disability-ness of their situation.
How does the Complex Question show up elsewhere? Oh man! Look at your continuing education pamphlets and the sales statements from the Physio Gurus out there. "How much better did you feel because of my maneuver?"  Oh! This statement has TWO! The presumption of feeling better can be affirmed with any answer AND we can affirm the presumption that the "getting better" was because of the maneuver. Even if they say "a little better" this solidifies, in the mind of the audience or patient, etc, that the result was "because of the maneuver." (There is an out in this example, the individual could say "I felt no better" but this statement is also heavily laden with Anchoring and Priming.)
Misleading Vividness, or Anecdotal Fallacy can mislead in a similar way, in that the argument presumes widespread prevalence or importance, based off a single event. A person may describe an event or treatment or maneuver in such detail, that it seemingly has more gravitas. Example: "I treated her with global exercise." vs "I started with the patient in side-lying, rotated the shoulder back 45 degrees and applied a rotational force through both the hips and the shoulder girdle in opposing directions. An audible pop was heard and felt stimulating mechanoreceptors at the joint and down regulating ion channels of the nociceptors in the area." The detail enhances the event. And, as we know from blinded research, isolated hands on manipulative therapy is no better than general exercise for many conditions.
The above works off a cognitive bias called Recall Bias, where things that are easier to recall seem more frequent and therefor more important. Think of being killed by the Flu vs killed in a plane crash. We are often more fearful of the plane crash because of the misleading vividness and recall bias. In this case, however, the Flu is statistically much more likely to affect you or your family. Perhaps in the above example, the times when you got a good 'pop' are more vivid to you than the times a patient got better with traditional therapeutic exercise, thereby increasing your impression of the technique. 
So, what to do about these? Listen. Slow down, stop if you have to. Go over the statement's words and locate what is actually being asked or stated. This is how you get around all the Fallacies of Presumption. Does the argument or statement assume anything? If so, can that assumption be agreed upon? In presuming a concept are you altering the context of your answer? Does this one event, as salient as it is, represent a majority of events.
*Note: we certainly make presumptions during conversation. They are often correct and are needed for the communications to commence.For example, we assume we are using the same meaning of words when we communicate. (this is not always the case!) Just watch out for these sneaky complex questions and anecdotes.
So, think about these questions. "It is experience bounced off the wall of thought and thrown into the sea of reflection that ultimately returns the reward of expertise."  
Stay tuned next week for more Fallacies!...
-Matt Dancigers, DPT

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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