Health as ecology

I am wondering if Gregory Bateson understood Brexit half a century before it happened better than we understand it as it unfolds. He talked a lot about schismogenesis, the development of a split between what become separate groups of people. This is the process of divorce, where some minor disagreement starts a process that magnifies the issues over time until they appear irreconcilable. I work with a mediator who understands the force of that process intimately. It is never about the “facts” or practicalities which the parties get so engrossed in. It just never is. Brexit is not about trade, or EU regulations, or immigration: rather these things are the ammunition hurled in a schismogenesis process that need not happen.

This blog was stimulated by an excellent lunchtime conversation between Nora Bateson and David Graeber. Many of the ideas are theirs and of course the mistakes are all mine. It is also part of some work that will be celebrated at the start of June in a Bateson conference in Poland. There Russell and I will be in august company discussing why in ongoing conversation about healthcare and about Brexit it is so hard to discuss the pattern rather than the issues.

It is possible that the presence of a number of truly reciprocal elements in a relationship may tend to stabilise it, preventing the schismogenesis which otherwise might result either from symmetrical or complementary elements. But this would seem at best a very weak defence: on the one hand if we consider the effects of symmetrical schismogenesis upon the reciprocal behaviour patterns, we see that individuals comprising the nations of Europe become more and more involved in their symmetrical international rivalries, they gradually leave off behaving in a reciprocal manner, deliberately reducing to a minimum their former reciprocal commercial behaviour. On the other hand, if we consider the effects of complementary schismogenesis upon the reciprocal behaviour patterns, we see that one half of the reciprocal pattern is liable to lapse. […] Behaviour which was formerly reciprocal is reduced to a typical complementary pattern and is likely after that to contribute to the complementary schismogenesis.

Gregory Bateson: Steps to an Ecology of Mind p71

If we focus for a moment on what is split in schismogenesis, what divorce divides, it is some sort of web of relationships. We may want to believe that this is about the UK government and the EU, or that it is about this husband and that wife, but those things themselves are only constituted as webs of relationships. The splitting process, as we see, has its force at many levels of detail from aggrieved, left behind citizens, to the internal machinations of the Tory Party, to the inability of the EU to manage the migrant crisis. Bateson is asking us to pay attention of the patterns of behaviour in those webs instead of getting caught up in the web ourselves and thinking it is about the supposed issues.

Complex webs of interdependency are seen in ecosystems, and we can study them via the discipline of ecology. Ecosystems are of course living systems, constantly regenerating themselves. We live in a time when many of these systems seem to be collapsing. Both health and healthcare are under dramatic pressure and being pulled into the political limelight. As an example we clearly cannot separate the internal drama of the UK Tory Party from the spasms the NHS is going through, no matter what we think of rights and wrongs and motivations.

Understanding links and patterns of links

To understand health we need a mental image of an ecosystem. We need to apprehend complex patterns of interdependency, so complex that we could never exhaust the further description of them for a specific system. Exchange and recycling of materials, the timings of interlocking lifecycle events, the mutual balance of population pressures, the stabilisation and maintenance of the local environment. This is a dynamic, oscillating, fluctuating, self-organising process. We need to understand how a thriving ecosystem generates health.

If we focus on a bilateral link between two living things, it can be a complex exchange of materials and information, of emotional cues indeed, or it can be the narrow and empty transactional purchase of some paperclips. As a culture we have a penchant for the latter, for the apparent reduction of our interdependence. It would not be too fanciful to talk of a schismogenesis between our cultures and the biosphere that supports us.

We cannot design an ecosystem. We can help support one, perhaps seed one and let it grow and develop. We can use ecological principles to underpin the designs we propose. A real ecosystem feeds on complexity of information and generates more complexity in response to disturbance. If we design a start successfully an ecosystem will evolve into what it needs to be. The notion of control is foreign here. We can, and do, disrupt ecosystems and even wipe them out. An ecosystem can be healthy, vibrant, robust or it can become stressed, unstable, fragile.

The use of the word health is crucial. And the bridge to human health is crucial too: to what extent are we ourselves an ecology? As “individuals” and as families and societies?  According to Michael Marmot, ninety percent of what we call our health is socially determined. Health is not a biomedical question, although we might say it always has biomedical correlates. Social isolation is far more harmful to health than smoking for instance. Marmot reports that Norwegian government ministers say they are all minsters of health, no matter what their portfolios. Their government decisions and policies largely determine the health of the Norwegians (and others!).

Our health is an ecology internally with the many organisms that compose and inhabit our bodies, it is an ecology socially since we are social beings moving in complex social relationships and underpinning it all is our fraught relationship with the biosphere, with soil and sea, with farm and forest, with air and atmosphere, that we want to pretend is like buying paperclips.

Paying attention

We have choices. The ecosystems that comprise us, and that we are part of, exist whether we acknowledge them or not. If we take antibiotics we severely damage our gut biome. The implications of that are more or less severe, close at hand or distant in space and time. If we choose not to know or to care, that is still a choice. If we care about the health of the various biomes in and on our body, we can take care to eat things that will nourish them and attend to our hygiene in ways that respect them. We will know that our very mood is largely governed by them.

Similarly with our social systems. We can pay attention to how our work affects our health, positively and negatively. We can pay attention to the education system, to the food industry, to consumer culture, to the migrant crises of our time, to climate change, to politics. None of these are separate or separable from our health. If we choose not to pay attention, the ecosystems we are part of are weakened, stressed, especially in their ability to find new ways to respond to change.

The best way to pay attention is probably to open up discussions. Educators and lawyers, climate scientists and people working with refugees: wherever there is an illusion of a discrete field of human study and action. This focused work is often cast as looking for solutions, for practical things we can do, for answers. But actually the system changes by the better, richer connections between human activities we like to distinguish between and separate. Those separations: teaching and cooking, banking and child-rearing, farming and scientific research, are ultimately arbitrary categories, large and small siloes and ghettoes. By allowing them to become ghettoes we simply fail to recognise the vital connections between them.

To pay attention we need negative capability as described by Keats. We need to be able to observe without “any irritable reaching after fact and reason”. The important action happens between institutions and we don’t have good language for describing how institutions set the context for each other, like public space emerging between buildings, without ever being part of the design.

The Gregory Bateson quote at the start came from a conversation he had with officialdom around a concern for how to regulate our behaviour when coming into contact with a tribe that had not be in touch with the western world before. His main point in that conversation is that we cannot apply the categories we use on ourselves (economics, social relations, sexual or religious concerns) to understand the observed behaviours of the tribe. Similarly, we cannot develop our own responses to the changing world while we hang onto these historical relics. New behaviour will need new categories and new behaviour we absolutely need, and need now. Economics is not a naturally occurring phenomenon of human societies. It is particular, local … and broken!

Neither is this an academic question, though studied with deep academic seriousness. Gregory Bateson asked whether his own lung cancer surgery was actually a placebo intervention.

As I see it there are many way of thinking about body-mind, and, of these, many are what I personally would call superstitious. For me these are unacceptable solutions to the problem of body-mind, and that phrase is my definition of superstition.

He asked as a result of his experience:

Do doctors make good patients? I mean, is it possible to be a good patient if you deeply believe in the philosophy of materialistic medicine? I suspect the answer is no.

The evidence from work done at the International Bateson Institute is that when people pay attention to the multiple contexts of a situation they make different decisions. The designation of multiple contexts is a partial mapping onto the different social institutions that we rely on to make sense of our lives. A decision about health may well be different if we consider the work context, the legal context, the climate change context as well as healthcare advice. The claim being made is that richer sets of contexts, which equates to higher decision complexity, translates into a more alive social ecosystem which can find a way through otherwise insuperable challenges.

The Master and his Emissary

In McGilchrist’s book The Master and his Emissary, the two hemispheres of the brain give rise to distinct worlds of experience. The left side with its need to name and classify things thinks that the world it so constructs is “true”. There is a social extension of that need to organise and catalogue of course, and we find our organisations are besotted by the need to plan and for people to sing from the same hymnsheet. The right side of the brain maintains a continuous grip on what IS but in a necessarily inarticulate way. The subtitle of this incredibly important book is The Divided Brain and the Making of the Western World.

What McGilchrist is very clear about is that when that servant emissary function usurps the master in that way, disaster at various scales in a necessary consequence. In a companion paper to this one, A More Efficient Flush Down the Pan, I explore why forcefully pursuing the implications of the reality the left brain creates destroys the real world that support us. The emissary function needs to return the results of it cleverness to be acted on by the Master. This was anticipated by Gregory Bateson in the title of another famous book: Mind and Nature: a necessary unity.

There is a fascinating conundrum in being a conscious part of an ecosystem that we cannot be fully conscious of. That is the conundrum that drives the issues in this paper. The professionals in our healthcare systems cannot understand their own personal ecosystem functions, nor the ecosystem aspects of those very healthcare systems. They must make reasoned, evidence-based decisions AND understand when those decisions have short-circuited the necessary complexity of the ecosystems themselves. Almost all our current healthcare short-circuits what is necessary for people to maintain their own health. The emissary is undermining the health of the master.

Our point here is that an ecosystem is what it is, and arranging society and its institutions otherwise may be an impressive display but must lead to failure and confusion. The nature of confusion is that we do not always know just how confused and lost we are. The social techniques that the IBI in Stockholm is exploring and developing are ways of sensitising ourselves to what we cannot fully know, and to expand what we take into account when we try to live into the massive issues we face. We need the focused and dedicated science we call healthcare and we need to make sure it is the servant and not the master. My own experience is that medical professionals really do believe that they know more about my health and how I might recover and maintain it than I do. The hubris and grandiosity of that position, and how we accept it quite passively most of the time, provide the energy and motivation for this paper.

Aidan Ward, May 2017

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