Brett Weinstein and Heather Heying have a t-shirt that says “Welcome to Complex Systems” on it.
Indeed.
Many patients and biological reductionism want to know what caused my anxiety, depression, hormonal issues, and autoimmune disease? What did I do wrong, or that went wrong for me? What was the food I failed to eat, the ingredient I was missing or the thing that caused the house of cards that represented my health to topple?
I think it’s appropriate to answer, “welcome to complex systems.”
Like everything else in nature, your body, your mental health is a complex system. This means that it consists of many factors, many of which have yet to be identified, virtually all that have yet to be correctly understood, that drive its function—even seeing health as an absence of disease, which is essentially how our medical system is organized, is a product of biological reductionism. Biological (or rather mechanical reductionism), the attempt to identify the loose screw or the spring that’s out of place, works for your car, but it doesn’t work for your brain, body, mental or physical health.
Understanding health might be better done using the Biopsychosocial Model, a framework for understanding where we sit today in terms of our health from the context of our biology, psychology, and social environment. Further, the biology part of the biopsychosocial factors that drive our health can be considered triggers and drivers rather than cause and effect.
Say you are feeling terrible. You’re feeling exhausted and agitated, and you’re constipated, and your hair is falling out. You see your doctor, and they tell you everything is great. You push for some bloodwork. Your doctor says your thyroid is slightly off, but it’s likely nothing.
So you take the bloodwork to your naturopathic doctor, who tells you your stimulating thyroid hormone, or TSH, is out of range, indicating that your thyroid seems to be under-functioning. They order more testing to understand what else lies under the hood and find your anti-thyroid antibodies are sky-high. It turns out you might have Hashimoto’s thyroiditis or a condition of under-functioning thyroid driven by autoimmunity.
You also have celiac and a family history of multiple sclerosis, thyroid issues, and other autoimmune diseases. How did this happen?
For months you were dealing with a ton of stress. You also haven’t been eating the greatest. But you haven’t been sleeping well either, and it’s hard to eat well when you’re so darn tired. You’ve been working a lot, dealing with a global pandemic and all, and things haven’t been great. But this is compounded by the fact that you’re not feeling great, which makes it harder to deal with the stress, making the condition worse–a vicious cycle.
At least now you know that something is going on, and it’s not all in your head, but what caused this?
We want to know the exact cause of something to find the specific treatment. This is biological reductionism. Something is missing; we’ve identified the thing, so here’s the magic bullet that will target the exact issue and either replace it or weed it out.
The problem with complex systems is that when we pull one thread on this ball of yarn that is your health, a knot gets tightened somewhere else. Like the post on Chesterton’s fence, complex systems are difficult to understand. So we must assume we don’t fully understand them, and therefore I believe we should exercise humility when it comes to tugging on pieces of yarn that comprise the whole operation.
For example, the side effects of drugs aren’t side effects; they’re effects. Some of these effects are wanted. But all the other effects that happen, such as weight gain, agitation, or migraines from anti-anxiety medication, are unwanted. And they are still effects of the drug. Side effects of drugs are indications that we have failed to understand the implications of messing with complex systems entirely.
Sometimes this might be warranted. The system might be so far out of bounds that it could kill you unless we intervene. Sometimes the drug is more specific–if you don’t have a thyroid, you need thyroid hormone. However, does the thyroid have a role beyond simply producing T4 (thyroid medication)? While thyroid hormone medication might be indicated or necessary, is it fully completing the thyroid’s function in the complex system? What about T3? (or T1 and T2)? What about iodine? What about the driver contributing to thyroid dysfunction? Is it still driving disease? Might it start to create other symptoms elsewhere in the body?
In other words, have we entirely dealt with the problem when we reduce thyroid dysfunction down to deficiency of a single hormone?
So, I explain to my patient; there isn’t a cause of autoimmune disease or a thyroid condition. There are drivers, such as chronic inflammation (which might be triggered by a specific food your immune system doesn’t like). There might be a driver like chronic stress triggered by a more stressful event. Genes can be drivers or susceptibilities triggered by environmental factors, such as nutrient deficiencies. So, it’s not gluten that caused your thyroid issue, but it might start or drive immune system overactivation and chronic inflammation, contributing to the problem.
So what does this mean for treatment? It means we need to look at the ball of yarn respectfully. We need to appreciate how many symptoms are a healthy response and compensation by the body. If we randomly attack a symptom like fatigue with a stimulant, we might further drive the inflammation, nutrient deficiencies, or stress that underly that symptom. We need to understand what the body lacks (what’s it deficient in?) and when it might have too many environmental toxins, allergens, chronic stress, blue light, etc.
We need to look at the system and help it re-establish its equilibrium. Cleaning up garbage in a pond is likely a good idea–it probably shouldn’t be there in the first place. The pond didn’t create the trash. But what about something else we don’t want, like an algae overgrowth? But if we throw an algaecide in the water, what unseen harm might we be doing to the pond’s ecosystem if we mess with it? Has the pond created algae for the reason that currently escapes us, but wouldn’t if we looked a little deeper?
Why doesn’t our modern medical model treat our bodies as complex systems? I’m not sure. A few guesses, though. Complex systems are complicated, if not impossible, to understand. They require time to unravel. They need patience and education. They require effort on the part of the patient to try to shift their environment to eliminate or adjust possible triggers. They are impossibly hard to market and profit from.
Getting our concept of a complex system “right” can take time. It might take trial and error, collecting information, curiosity, and a willingness to try. It might take admitting that our culture has many aspects to it that are inherently unhealthy.
We might have to find a mini culture where people get sun, eat well, move, and sleep early to support our health. We might have to be “stricter” than the people around us. These people may have similar drivers working below the surface, but their symptoms may look different. They do not display symptoms like fatigue or anxiety until their systems have completely shifted beyond balance.
We are all a manifestation of complex systems. Laini Taylor says, “Inside each of us, there is a world that no one else can ever know or see or visit.”
