1 Boring Old Man

The straw man fallacy is a ubiquitous technique in argument – easily observed on the nightly news in a period like this when there’s a primary campaign underway. It involves simplifying and weakening an opponent’s view, then attacking this lesser version. It can be used most skillfully by keeping the invented position of your opponent close to the truth – for example, stating their position correctly but distorting the motive behind it. Another common method is to taking a position arrived at reluctantly in the face of difficult alternatives and arguing against it as if it represents an unambivalently held belief. In formal debate where judges are particularly focused on fallacy, debaters are judged by their ability to handle the straw man fallacies that inevitably come up in the course of an argument. It’s one of the things that can make adolescents so maddening. They’re newbies to the capacity for abstract thinking and delight in flexing that skill in endless debates – moving easily from straw man to straw man [it’s one of the easiest fallacies to create on the spot].

Anyone involved in a psychotherapeutic endeavor of any depth knows what it feels like to be a straw man. It’s the essence of transference, the distortions a patient makes based on previous experience and an essential feature in understanding the patient and the baggage they bring to their interpersonal life outside to consultation rooms – often the very source of the problems that got them there in the first place. One becomes used to being contorted on a regular basis. Added to that, there’s nothing about being a mental health type that immunizes one from having the same kind of glitches patients bring to the table, defensive distortions of one’s own that patients regularly locate and comment on. The personal frailties of the therapist or psychiatrist are grist for an endless string of dramatic plots – the wounded healer. And then there are those other things, like "making a living," having a life, or wanting to be valued by others – personal motives that clash with a patient’s wish for the unconditional love and devotion of the parent they didn’t have. But one learns to accept and value the position of straw man, because it is one of the pathways to helping people make necessary changes.

I think those of us who are criticizing the DSM-5 effort need to consider whether we are making Straw Men of the DSM-5 Task Force. We are accusing them of having conflicts of interest in their current [or recent] ties with the pharmaceutical industry. We are accusing them of being part of a cohort who has a particular view of mental illness that is, as of now, not yet evidence-based but rather hypothetical. We are accusing them of having a fixation on pharmacological treatment. We are accusing them of being in a cohort that has produced an embarrassing record of corruption, both scientific and otherwise. We are accusing them of adding things or changing things that will lead to an increase in the use of psychotropic drugs. I am, in addition, accusing them of stepping out of bounds by focusing on treatment and implications in their diagnostic deliberations, rather than sticking to their assigned task. Unfortunately, the only access we have to judge their work are their published drafts, and the limited comments of their leaders – the APA Presidents, Dr. Scully who is the APA Director and CEO, and Drs. Kupfer and Regier who direct the Task Force itself – since the members are essentially sworn to secrecy [above].

So, in the way I wrote that last paragraph, did I, in fact, make them into Straw Men by presenting them in a distorted light? Maybe, but probably not. But it doesn’t even matter. The standard for conflict of interest has always been the appearance of conflict of interest, not being a convicted felon. And there’s no way that I know of to write that paragraph that doesn’t contain the appearance of conflict of interest. It reeks all by itself.

^{In a statement, APA medical director and ceo James Scully says the DSM-5 development process “is the most open and transparent of any previous edition of the DSM. “We wanted to include a wide variety of scientists and researchers with a range of expertise and viewpoints in the DSM-5 process. Excluding everyone with direct or indirect funding from the industry would unreasonably limit the participation of leading mental health experts in the DSM-5 development process.”}

^{In their article, “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists,” which appeared in the March issue of the journal Public Library of Science, and which ABC and other news outlets quoted, Cosgrove and Krimsky question the work of DSM-5’s volunteer Task Force and Work Group members because of publicly disclosed relationships with the pharmaceutical industry. Although we appreciate that Cosgrove and Krimsky acknowledge the commitment the American Psychiatric Association (APA) has already made to reducing potential financial conflicts of interest, we strongly disagree with their analysis and presentation of APA’s publicly available disclosure documents. Specifically, the Cosgrove-Krimsky article does not take into account the level to which DSM-5 Task Force and Work Group members have minimized or divested themselves from relationships with the pharmaceutical industry.}

And speaking of creating Straw Men, instead of listening to the hard-earned wisdom of their predecessors, Drs. Robert Spitzer and Allen Frances, the Task Force leadership has interpreted their opposition as being nosy-parkers, driven by financial motives and the pride of authorship – that, in spite of both men openly reflecting on the mistakes and unintended consequences during their times in grade. My last post was about a well conceived critique of the DSM-5 Task Forces’ efforts written two years ago, but it could’ve been written last night – highlighting the fact that they’ve heard nothing in the intervening years.