December 10, 2014
Much of my work over the past 12 months has been helping clients and teams of stakeholders to lead the transformation of systems (like food and health systems) and to discover new ways of working and being together – ways that serve us well in the context of complexity and uncertainty. This post weaves together a personal story of with lessons from my work.
Recently I’ve been struggling with an injury sustained whilst doing a simple stretch at home. When my sterno-clavicualr joint popped out, the effect was an immediate spasm of all the intercostal muscles around the my rib cage. It appeared that the disruption of this single joint caused my whole musculo-skeletal system to seize up, resulting in significant breathing problems and widespread pain. When the joint miraculously ‘popped’ back into place, the relief was as immediate as the onset.
When I look at the diagnosis of this injury through a simple cause-effect (or mechanical) lens, the diagnosis and treatment path would/should look like this …
Over-stretch causes Sterno-clavicular joint to pop-out –> Pop the joint back in and allow any damage 4 to 6 weeks to repair –> Fixed! Simple right?
That makes sense doesn’t it? It’s mechanical after all, like when we break a bone … bone fractures –> have the limb cast (or even plate & screwed for more complicated fractures) –> bone repairs over 6 to 12 weeks –> resume skateboarding!! Well, it’s been 4 weeks since the injury and my progress hasn’t felt quite so simple and linear. Technically, the above linear pathway showing [cause –> effect –> remediation] is an accurate reflection of what has happened. But, I have since learned that the ‘underlying’ cause of the Sternoclavicualr joint injury is far more complex!
The complex process of treatment and rehabilitation begins …
After a couple of session of observations, conversations about pain sites, work habits and past physical/medical history, my Osteopath discovered a complex pattern of underlying, causal factors that contributed to my injury. Together, these factors (like tight hamstrings and assymetrical posture) interact with each other to create an emerging pattern of dysfunction. Translated to English = the many little problems with my body mechanics create weaknesses that make me more vulnerable to injury. So, like in all complex systems (watch the Wolf in Yellowstone National Park video below) the underlying cause of my sudden injury is not that clearcut. The remediation of these multiple factors is even more complex.
In the field of Complexity, we call these factors ‘Multiple Interdependent Variables’. Multiple being the ‘many’ parts/factors. Interdependent meaning the mutual dependence between parts/factors such as general posture, muscle flexibility/stiffness and even mental state. In my Occupational Therapy career, I discovered long ago that there is great deal of interdependence between our psychology and physical functioning.
Osteopaths understand how to work with complex patterns of physical dysfunction
Now that my Osteopath has a better understanding of my particular challenges, she has begun hands-on treatment supported by a home exercise program. The first thing she said was that there is “no quick fix for you Geoff”. She also said there were many ways of tackling my problems and that she would start with a combination of interventions including deep tissue massage, dry needling, passive & active stretching/resisting exercises. She explained her theory using anatomical diagrams and it made good sense. But she also admitted it was impossible to know what effect these multiple interventions would have on my pain levels or postural/structural alignment – “We’ll have to watch closely and see what happens” … “What works with 1 person doesn’t necessarily work with another” were some of the things I heard her say.
Recently, after a series of stretches and dry needling, I hear her say “Oooh look! That did something … your hips are now more aligned in standing, but in lying they remain imbalanced? Ok, let’s now try this …”
In Complexity (using the language of Dave Snowden of Cognitive Edge), my Osteo was probing my system (i.e. my body) with a few safe-to-fail treatment options to see/notice what would happen. They are safe-to-fail because if dry-needling doesn’t appear to work, I’m not going to be left incapacitated and we try something else. This way of working is rapid and iterative and produces immediate feedback loops. This allows us to sense if something works (or doesn’t) and from that learning we quickly respond by trying something else or doing more of the same.
In sum … my Osteopath’s way of treating my complex set of interdependent problems is to Probe -> Sense -> Respond … then Probe -> Sense -> Respond … and so on. This iterative process can happen within a single treatment session or across a few sessions.
Applying this way of working to other arenas of life
No therapist can predict what difference a specific treatment (or set of treatments) will have on complex problems like the one I have described. There is no strategic plan and we don’t know the outcomes in advance. The only way to make progress is to ‘do something’ and interact or disrupt part of the system (my body). That action (no matter how small) produces some sort of emergent effect or change – it’s emergent because of the relationships between the different parts of my body. The task is then to watch closely and quickly measure/discover what happens. Armed with a better understanding of the system itself you then respond.
The whole point of this post is to point our that most of our big challenges like tackling obesity and creating resilient communities are highly complex. Complex social challenges are defined by 3 characteristics:
The situation is emergent (1) and as a result … there is constant flow of information (2) to negotiate and this means … actors are constantly adapting their behaviour (3).
Too often we treat these complex challenges as if they are complicated or simple. We assume that we know the outcomes of our actions and we pay little attention what is really happening in the system itself. Many clients I work with have little time for experimentation and work in risk adverse cultures where failure is taboo. Funders of project teams tackling complex challenges still want to know plans and how actions will produce desired outcomes. And at the end of the project we (play the game) and write reports back to funders that somehow shows how our project lead directly to the pre determined outcomes.
Deep down, we all know that the emergent, unexpected impacts of our work are often the most important things to pay attention to. If we are lucky, we will have a funder that allows iterative changes to our plan as the project unfolds. In very rare cases, funders will even allow the pre determined outcomes to change in response to our early project learning.
What else to read & watch
This post was inspired by Chris Corrigan’s post –> Back from a Cynefin Deep Dive. If you want to learn more about complexity and a very cool decision making model called the Cynefin Framework, dig into Chris’ post and the embedded links to other goodness.
Also, please watch this video on how Wolves change the course of rivers in Yellowstone National Park. Taking the wolf as a metaphor … what could the ‘wolf’ represent in the system that you work in?