HOW DO YOU THINK?
May seem like an odd question but it's a good place to start. Learning can be enhanced by thinking out loud. Below is me doing just that.
We all talk to ourselves but do you ever ask yourself questions like the one above? Or questions like “It’s great that I’m learning a lot but how do I apply it in a meaningful way?”
We can become veracious consumers of knowledge but if we don’t seek to connect the dots with guiding principles for thought and reflection we might miss out on the bigger picture.
The most impactful book I've read to facilitate my learning and reflection process is Donella Meadows' book: Thinking in Systems: A Primer. The last chapter titled “Guidelines for Living in A World of Systems” in particular offers a simple but salient framework for thinking about systems thinking.
I’m on a lifelong quest to better understand human health and wellness. As a PT, I am mostly interested in biological systems but if you read on you'll see that's not enough. Studying human behavior, (movement being one aspect) can be assisted by complexity science. It gives us the organization from which to start and on which to fall back.
The study of complexity does not negate the appreciation of simplicity. It is in fact part of the goal. In the guidelines Meadows outlines below there is beauty and pertinence that can truly be appreciated when you apply them yourself. I’d like to share her brilliant words and my thoughts.
“Before you disturb the system in any way, watch how it behaves. Study it's beat. Learn it's history”
We live in our own bubble of biases. It is in our evolved nature to want to predict but the more time we take to step back and observe (our patients AND our own thinking-both being systems) the more success we will likely experience moving forward.
I like a lot of music that may sound complex at first but in every song you can pick out simple beats. Appreciating complexity involves taking a step back to observe that simplicity, filtering out the noise to hear it, realizing the noise may be part of its appeal.
"Remember, always that everything you know, and everything everyone knows, is only a model."
"Instead of becoming a champion for one possible explanation, hypothesis or model, collect as many as possible."
Be open to sharing your models and discussing them. Have conversations with folks who practice differently than you. You might learn something. They might. You'll likely both grow in some way. As Meadows says: "it is necessary to become mentally flexible and willing to redraw your boundaries."
"A decision maker can't respond to information that he or she doesn't have...that is inaccurate... or information that is late"
"99 percent of what goes wrong in systems goes wrong because of faulty or missing information"
There are many applications for this point but fundamentally it is about communication.
This is exactly why it is important to do a thorough assessment of any problem you are trying to solve. I think a lot of what I do is help folks transform their perceptions, like changing beliefs on pain via education or working to improve movement via stimulation of various receptors.
Language is one means by which we create meaning for each other and ourselves. We should be diligent in our choice of words internally and externally. Words are our best tools for enabling changes in thought perceptions. My mom speaks six different foreign languages. While I can’t boast that I do as well, in my own way I feel I speak a lot of different languages.
“Be a quality detector”
Leverage points are the points of power in a system where one can try to produce change. Numbers are last on the list of effective intervention points (ie, least effective) according to Meadows. Measuring is important but there are a lot of important things that aren't measurable. How do you measure: Perception? Daily experience? Friendship? Grief? etc.
Our obsession with normative values is likely multifarious, including existing paradigms we have on progress. Ironically "Transcending Paradigms" is the highest leverage point.
Resiliency is at its essence being able to respond to change. To do this and be sustainable a complex system (like a human) must have feedback loops.
Whether you want to grow (increase resilience via strength/ power) or stabilize (maintain homeostasis) in patients and athletes one must understand the feedback loops and the relationships between multiple sub-systems. For example, how does the nervous system and endocrine system and the musculoskeletal system interact to produce hypertrophy?
Ideally, positive and negative feedback loops work to create overall positive change without negative consequences. This makes me think of my new favorite mathematical equation STRESS + REST = GROWTH.
"Aim to enhance total systems properties, such as growth, stability, diversity, resilience and sustainability-whether they are easily measured or not"
Parts should be appreciated but only within the context of the whole. Even with an increased appreciation for regional interdependence we tend to still view problems in a very myopic sense.
I catch myself doing this all the time. Then I do this mental drill. I literally imagine myself stepping back a few steps from my patient to view them as a whole. This enables me to see more dots but reflect on how they do/might connect. You can step in and back out as much as you need to.
Going for the good of the whole to me means understanding someone’s ecosystem (social realtionships, nutrition, sleep, etc).
"Aid and encourage the forces and structures that help the system run itself. Don't be an unthinking intervener and destroy the system's own self-maintenance capacities. Before you charge in to make things better, pay attention to the value of what's already there.
We place most of our attention on what isn't "normal” often forgetting the value in focusing on the things that are working well.
I love this message from the book Seeking Wisdom, by Peter Bevelin: "Look at where the bullet holes are, and put extra armor everywhere else." I rarely, I mean really rarely, tell my patients to stop going to the gym.
This nugget is also a reminder for me to not forget to ask my patient/client what they think. Their opinion matters.
"Look for the ways the system creates its own behavior."
"Sometimes those outside events can be controlled but sometimes they can't.”
When we consider movement in the larger context of the human system there are several ways to influence this output but there are some things that are not controllable. We have to work with what we know and can influence.
Sometimes the factors influencing pain or movement are not what we'd expect. In Topical Issue in Pain 2 Louis Gifford lists a hierarchy of influencers on pain and disability and states "some levels are more powerful than others in influencing the decline or wellbeing and recovery; these relate to the environment, and the thoughts, feelings, beliefs, behaviours and functioning of the patient"
"The thing to do when you don't know, is not to bluff and not to freeze, but to learn"
This might be my favorite wisdom point. Are you willing to change if your learning sends you in a different direction? Do you error-embrace? We learn as Buckminster Fuller said “by trial and error, error, error.”
"Lets face it, the universe is messy. It is nonlinear, turbulent and chaotic. It is dynamic. It self organizes and evolves. It creates diversity, not uniformity"
Human minds love straight lines, whole numbers, uniformity, and certainty- yet there is much more to be celebrated in the complex and the unknown.
I'm cool with the Information Age but can't we simultaneously have the Reasoning Age? Data exists in abundance but when you travel down that rabbit hole what do you find?
Two key factors in valuing complexity are relationships and change.
"Actions taken now have some immediate effects and some that radiate out for decades to come"
You need to consider short term and long term. Short term goals (eg. pain reduction) are important but I am always thinking long term. Long term goals for me are the "what if" type of questions. What would you want to accomplish if you didn’t have low back pain? Even longer, what are your goals past discharge?
It’s not a coincidence that the only book I re-read cover to cover, multiple times a year is This is Water by David Foster Wallace. My favorite line is “Your education really is the job of a lifetime” My discipline is physical therapy. I read books about psychology, philosophy, physics, nutrition and immunology, just to name a few. I take continuing education courses from PTs but also from chiropractors, strength coaches, athletic trainers, osteopaths and nutritionists. I write that and think to myself: I need to branch out.
because "The REAL system is interconnected"
When I first read that: expand the boundary of caring I paused. I paused because it is something I believe in, and hope for, for our humanity and our world.
I feel incredibly lucky to have a passion for my job that grows yearly and if I leave any legacy for my kids I hope its this.
We pay more attention to bad behavior, shocking news, controversial tweets than we do those with good intentions.
"It is much easier to talk about hate in public than to talk about love."
I believe we need it all, idealism, skepticism to cynicism and everything in between. Most days though, I'd rather hear about how and why someone thinks they can make a positive influence vs. what they feel others are doing incorrectly. This doesn't mean I'm critique-averse, rather, believe there are more constructive ways to disagree.
We live in a world of complex systems. They are everywhere, around us, within us. To be successful in life I think we need to do more than gain an appreciation for complexity.
Learning to appreciate uncertainty and acknowledging there are several factors involved in the output of a system is a start. To delve deeper we can use mental models that help us learn how to understand system behavior with the intention to better predict and intervene.
Thanks for letting me talk out loud as I try to level up my thinking!