Complexity and Behavioral Health: Complex, not Complicated

In my previous post, I began to explore the limits of Evidence-Based Practice in behavioral health.  My thinking about this evolved during my tenure as SAMHSA’s Senior Advisor for Process Improvement.  My own background was not in behavioral health, but was in organizational change leadership.  Over the past 14 years, my work has been most greatly influenced by my study and understanding of what are called “complex adaptive systems.”

With a minimum of explanation and jargon, the systems we live and work in – and the problems we face – fall into two basic categories.  One type are technical problems.  If we know the right stuff, have the right resources and people, we can fix the problem every time.  This is a domain of “known knowns” and “known unknowns.”  It is also the domain of best practices and experts.  Get the engineers and designers, and you can build a great car or smartphone.

The other basic type of problem is what Ron Heifetz, professor of leadership at Harvard’s Kennedy School, calls “adaptive” problems.  We all see the world through the lens of our own lived experience – our norms, and values.  What we believe and know and expect.  So when we are faced with a truly complex adaptive problem – lowering the rate of teen prescription drug abuse, for example – it is a lot harder than building the next iPhone.  Any change from the status quo will be a move away from the beliefs and expectations of some of us, and towards the beliefs and interests of others.  That movement creates tension, and that tension creates conflict.  What will we do?

This is a world of “unknown unknowns” and “unintended consequences.”  We do not, or can not know everything we want or need to know before we try a new policy or procedure.  Sure, maybe that ad campaign worked in the northeast on teen drinking.  But how will it work among Southwestern tribal teens?

Humans do not behave like machines.  As with many systems in nature, our patterns of behavior are not stable, predictable, and controllable.  We WISH they were, but we KNOW they really are not.

Here are a few characteristics that define and distinguish COMPLEX systems:

AUTONOMOUS AGENTS:  Individuals in the system can choose, think, believe, and act more or less as they wish (bounded of course by held beliefs values, knowledge and resources).  Put another way each of us is capable of “doing our thing” anytime we want. Complex systems are then NON-LINEAR (do not always follow the same sequence of steps) and NON-DETERMINISTIC (we do not necessarily get the same result every time even if we think we did the same things the same way as last time).

EMERGENT PATTERNS: Seemingly random interactions can suddenly and even dramatically shift to new and unforeseen patterns of behavior.  The Occupy movement has no leader or defining moment of conception.  Likewise the Arab Spring.

CAUSALITY BACKWARD:  In a technical system, like making a car, we can know the steps, and know what the outcome will be in advance- every time.  In a complex system, a study of the parts or people will not necessarily predict the behavior of the syustem into the future.  The only way to get a sense of causality is to look backwards from where we are at, and try to understand how we got here.  This has particular bearing on the relative merits of Evidence-based Practice versus Practice-Based Evidence.

SELF-ORGANIZING: as with systems in nature, complex human systems typically self-organize.  We come together and act together not because any law compels us, but because our understanding of various ideas will attract or repel us to act.  These forces are called ATTRACTORS OF MEANING.

How does this relate to the work of substance abuse prevention, especially through community coalitions?  Read more in my next post.

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