Complex is not (the same as) difficult (9)
Pieter Jansen and Fredrike Bannink
Analysis and synthesis
The concept of Positive Health Care (Bannink & Jansen, 2017) has, just like the philosophy of science, two ways to make the world and life comprehensible: the analysis paradigm and the synthesis paradigm.
Analysis refers to the process of reducing a complex whole, or system, into its constituent parts and examining those parts in isolation, assuming that it teaches us something about the whole when we put the parts together again. The assumption underlying the concept of analysis is reductionism, the idea that all the reality of our experiences can be reduced to indivisible parts.
Analysis is also looking back, assuming that it teaches us something about the future. It is about the question ‘why’ something is as it is.
The traditional medical model is an example of this cause-and-effect approach.
However, the world is often irregular and things are constantly changing. Examination of parts, or learn from the past, is not always useful. Synthesis is about putting things together; in complex dynamic systems this leads to the combination of things never thought of as ‘going together’, to create new concepts, solutions, or realities.
In synthesis, we use the effects of mutual cohesion and dynamics. It is about the question ‘how’ an outcome can be achieved that was not there before, using the context.
The solution-focused model is an example of this functional approach.
It is only possible to look inward when there is an outside world, and to look at the past when there is a future. Both paradigms are complementary and interdependent. Analysis without synthesis has no meaning and vice versa. However, the balance is not always in the middle. What are the extremes?
In a regular and stable environment the analysis paradigm works well. An example is:
- We can fairly accurately calculate the position of planets in our solar system hundreds or thousands of years ahead or in the past.
The most unstable environments we find on the smallest level or in conditions with many interactions. Examples are:
- In quantum mechanics calculations (predictions) are impossible. Only observation is possible, whereby the observer is part of the observation. There is no reality without an observer; there is no objective reality. The analysis paradigm in quantum mechanics is therefore marginal.
- The position of planets can be predicted many years ahead, but the position of a molecule in a liquid or gas cannot be predicted even a second ahead.
In health care, we are at the interface of (in the transition area between) planets and quantum mechanics. Uncertainty and complexity can not only be tackled with (an excess of) analysis. Parts of systems have properties that they lose when separated from the whole system, and the whole system has essential properties that none of its parts does. Analysis
ignores the central role of interdependencies.
Therefore we also make use of the synthesis paradigm and work on progress with the combination of both analysis and synthesis. We see it as ‘the best of both worlds’.
Further research should be done comparing both models. As far as we are concerned, this is not just research on reductionistic indicators – the analytical approach. Research should also be about whether patients are making more progress with either method or perhaps with a combination of them. It is about putting people first, not the disease or problem.
An example of this is the recent research in psychotherapy, comparing traditional cognitive behavioral therapy (CBT) (using the analysis paradigm) and Positive CBT (Bannink, 2012, using the synthesis paradigm) in the treatment of major depressive disorders at Maastricht University, the Netherlands. Positive CBT takes the preferred outcome of the patient as a starting point and not the reduction of symptoms.
Preliminary results show that Positive CBT, on all outcome measures, significantly outperforms traditional CBT. Moreover, qualitative research showed that almost all patients preferred Positive CBT over traditional CBT.
Another paradigm requires different research. For us this is beautifully expressed in the poem below.
To go in the dark with a light is to know the light.
To know the dark, go dark. Go without sight,
and find that the dark, too, blooms and sings,
and is traveled by dark feet and dark wings.
Bannink, F.P. (2012). Positive CBT. From Reducing Distress to Building Success. Oxford: Wiley.
Bannink, F.P. & Jansen, P. (2017). Positieve gezondheidszorg [Positive Health Care]. Amsterdam: Pearson.