Complex is not (the same as) difficult (3)

Pieter Jansen and Fredrike Bannink



Change is happening all the time, stability is an illusion. Complexity is unavoidable, so we better take it seriously. In the medical profession, however, it is not yet common practice to work with complexity. It takes courage to leave the beaten path, but turns out to generate good results and is (even more) fun to practice.


The butterfly effect: A wingbeat of a butterfly in Brazil can lead to a tornado (or nice weather) in Texas months later.

An everyday example: I left home a little late and missed the train. And then…….

The metaphor of the butterfly shows how a small change in the starting position can cause major differences in a later stage. Especially when there are many factors with many mutual interactions.
In modern science, two important paradigms can be distinguished: the analysis paradigm and the synthesis paradigm.

  • The analysis paradigm uses reductionism as a working method. We try to understand a system by dividing it into constituent elements. These elements are examined in isolation and the system is seen as a sum of the elements. However, this requires linearity. But pure linearity only exists as a theoretical model, a simplification of reality. Small variations and the truly innumerable interactions between all elements make the real world a nonlinear affair. When using this paradigm, it is assumed that if one analyzes long enough with ever stronger microscopes and more powerful computers, eventually everything will be known. This is the dominant paradigm in contemporary science.
  • In addition to analysis, science distinguishes the synthesis paradigm. Here, one does not see the subject as the sum of its components, but one looks at how the parts interrelate to form a whole. It focuses on the dynamics between the parts. It concerns complex systems that are characterized by these interrelationships. In Wittgenstein’s words: “Do not ask for the meaning; ask for the use.” Not the why is important, but the how, the function.


A characteristic of a longer existing paradigm is that it is no longer consciously experienced. Education makes a paradigm natural, making it more difficult to think outside this framework. Reductionism is important because it has yielded great successes in science and technology. The tremendous changes of the past centuries in our daily lives and also in medicine are largely due to reductionistic research. It certainly has brought us a lot.

But what is the alternative when reductionism does not appear to be suitable for highly complex topics? In those cases we advocate the use of the synthesis paradigm.