In Pursuit of Understanding, Pt. 3

Butterfly Effects: Missing Flights, Wild Turkey and 4th ribs

[In a complex system,] if a butterfly flaps its wings, you could potentially have a storm form somewhere that wouldn’t form somewhere else… Like many things in systems science, metaphors are used and misused. [And while the butterfly effect metaphor is often misused], it is true that changing initial conditions would change the outcome…For example, if you wake up 5 min. late, you might miss the bus. If you miss the bus you might miss another connection and you might miss your flight. So something very small can end up in a very big change.

It would seem that, in many instances, therapists benefit from the existence of the butterfly effect, but neither appreciate or understand it. Even still, in many instances, they rely on it. Recently, I heard a podcast with a researcher/clinician who argued that distal lower extremity pain could be understandably effected by the application of manual forces to the 4th rib in the thorax, correcting for less than optimal alignment of the thoracic cage. The individual was able to – biomechanically – account for how this might happen and it sounded incredibly impressive. As a matter of fact, it was humbling to be reminded of how little one knows; such was the case for me as she so easily and quickly rationalized through the anatomy/kinesiology on her way down the chain from thorax to foot. Of course, the clinician admitted, 2 patients may present with the same complaint in the lower leg and the same positive finding (with palpation) in the thorax, but only one may be a ‘responder’. The pain may persist in one individual, while it is reduced or abolished in the other.

How can that be so? If the biomechanical reasoning is so sound – and it is – how is it that the pain persists?

There are things that are – for all practical purposes – unpredictable…As the system’s behavior diverges, you get a kind of horizon beyond which prediction doesn’t make any sense….We need to make a very clear distinction between complex and complicated, because we often confuse the one for the other. Complicated is very much a machine-type system. In a complicated system, we can design, we can predict its behavior, and we can control its behavior. We can do none of these things with a complex system…

Let’s look back to the example of the bus from the podcast: What if, on the same day that you woke up 5 minutes late, there was also an accident on a nearby highway, which backed up traffic down the on-ramp 3 blocks from your bus-stop. Granted, you had to wait for the next bus, which was later in the commute, so there was heavier traffic, but did you realize that the traffic was actually heavier and slower more than is typical, because of the accident? Did you realize that the accident had involved a tractor trailer whose contents were spilled all over the highway and took an inordinately long time to clean up? Did you know that this accident (and the traffic delays as a result) was so bad that you would have been late for your flight even if you had woken on time? Of course, you don’t know any of that listening to your iPod instead of the traffic report on local radio. While you are jamming out to Pearl Jam angrily blaming last night’s extra shot of Wild Turkey for your tardiness, you are unaware that a truck driver spilled coffee on his lap 5 miles from your home and you are going to miss your flight as a result.

When entities interact, they create complex behavior, and they start connecting with each other. It is not only a matter of connection, it is also a matter of interdependence that then arises from that connectivity…A lot of complex systems you can actually represent the connectivity as a kind of network (paraphrase) drawing all the entities and all of the entities that they make contact with along that network. The structure of the network effects very strongly the speed of transmission of impulses or signals along the network and where they spread to. If highly connected, one entity can impact a large number of other entities…We often assume that connectivity is the same over time, but it is not. The quality and intensity of connectivity varies all the time and we need to understand that connectivity is not the same over time. It does vary.

What if you knew a the coffee-shop hostess had mistakenly not sealed the truck driver’s coffee cup completely? What if you knew that it was her first day working with a cast on her non-dominant left hand that she broke over 2 days ago when her 60-pound mongrel unexpectedly chased a stray cat while on an otherwise pleasant walk, knocking her to the ground?

How could you imagine that a cat garnering the attention of a dog (45 miles away) would eventually lead to you missing your flight 48 hours later? You couldn’t, and that is the point.

Waking up 5 minutes late is the positive finding at the 4th rib. Sure, waking up on time might help. So too might placing your hands on their thorax. But even if there is no accident, you arrive to the bus on time, the woman doesn’t break her wrist, the driver doesn’t spill his coffee, there isn’t an accident on a highway, the bus driver gets you to your connection on time and that bus driver gets you to the airport on schedule…do you get to take credit for all of that, because you had the resolve to get up on time despite that ill-advised shot of Wild Turkey? No, you get to breathe a sigh of relief every morning when things just happen to work in your favor. Likewise, a physical therapist should breathe a sigh of relief when their patients improve, not pat themselves on the back when the patient is “rehabilitated”.

Tomorrow – What “Rehab”?

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