In Pursuit of Understanding, Pt. 1

Emergence is a really interesting phenomenon. Emergence is when the system does things on the systems scale that you would not be able to predict from the components and how they interact. Let’s take the human brain: it is a complex system. The entities are neurons (nerve cells). They’re connected to each other. They send signals to each other. They are all very simple, and in fact you can write down mathematical equations which are quite good representations of what neurons do. But, now you connect a huge lot of them together and out of this comes things like consciousness – we are actually aware of ourselves and our surroundings in this rather big, big way. There is nothing in the structure of a neuron that says it’s got to do that, that (in a sense) the neurons don’t know about that; yet cognitive scientists would say that this is not some extra/external thing that is wonderfully being imposed by some[thing] supernatural…You can understand little parts of the brain, but even that is quite difficult… All of the evidence is that, somehow, what all of the wonderful things that the brain does – like language, like vision, hearing, taste, our senses, our movement – all of this happens by neurons exchanging electrical and chemical signals along the network. The network changes as we learn. The network changes as we grow from babies to adults… What it (the brain) does may not be as complex in itself as all of the underlying details. When I am talking to you, we could describe the whole conversation in ordinary language very, very clearly. If I tried to find out and write down what all of the nerve cells in our brains were doing when that happened it would be impossible to describe.

Once that emergent is in place, there is an additional dynamic. The emergent has 2 effects, it both constrains certain behaviors of the interacting entities (because there are existing systems in place) while, at the same time) it opens up new possibilities. And that makes it a very, very dynamic process. It is not only a bottom-up process, it is also a top-down process and the whole thing is changing very dynamically the whole time.

Recently on Facebook, I posted (on 2 occasions) a link to a podcast from In Out Time with Melvyn Bragg  on the subject of complexity. In a related post, I wrote, “Physical Therapists continue to fail to addresses patient’s complaints of pain because we have – and continue to – insist on creating complicated explanations and models that are necessarily insufficient to understand our patients complaints. When will we learn? The problem is one of complexity, not complicatedness.”

A few years ago, I would have viewed such a remark to be an exercise in semantics. Today, I have a better understanding of how the words we use necessarily shape how we think and how we interact with our patients. As a result, I would like to take this opportunity to review some of the important ideas that I took away from this particular podcast and how they may relate to physical therapy practice – especially when providing care to patients with painful problems.

So, how is the idea of complexity related to physical therapy?

Complexity is a point of view about systems in which large numbers of agents or entities which interacting according to fairly specific rules. The idea is to set up a mathematical model to represent that kind of system in a very accurate way.

Sound familiar? How about that part of us that is 25,000 cm² in size and comprised of 100 Billion neurons in the brain alone, each with 1000 to 10,000 synapses. It is that part of us that – if we lined it up each piece from end to end – would be approximately 600 miles long.

Yes, I am referring to our nervous system, arguably the most complex thing that we, as humans, have ever studied (or ever will). Thus, to be clear, all of our conscious experiences and everything that makes us who we are is necessarily derived from the most complex of complex systems. If you are a clinician working with patients in any field of medicine, you must appreciate the complexity of the system with which you are interacting and embrace the idea that you indirectly become a part of it.

Of course, complexity goes beyond neuroscience. The science and study of complexity applies to a variety of subjects from how birds flock, to metropolitan design, to economies, to weather forecasting and medical management. For instance:

From a more practical point of view, [an understanding of complex systems] would allow us to be able to do things like manage an epidemic better. This is a major problem. You know that there is a disease coming…but what strategies should you use as a government to try to contain the outbreak better? So if you have mathematical models that are good enough, you can try strategies out on the models. You can do experiments on the models which you cannot do on the real world and you can maybe learn how to deal with these problems.

So, scientists are using complex systems models in an effort to try to understand a variety of phenomena in our world. But how does this apply to physical therapy, specifically?

Tomorrow – Reframing The Therapeutic Encounter


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