Integrated Dimension
Dr William House, 2016
Wholeness is not achieved by cutting off a portion of one’s being, but by integration of the contraries
Carl Jung
Whether we see the world as a collection of parts or as an interrelated whole makes a world of difference. In the one you see parts, and in the other you see relationships.
Take the story of the blind men and the elephant …
Of course, these learned men all thought they were correct. After all, they were making observations from life. This is how we try to make sense of the world. Empirical observation is a key part of science.
Being integrated means being able to see how the parts form a whole. It’s easier to be deluded about this than you may think. We can all be blind to the bigger picture. This is a particular problem in medicine and in healthcare more broadly.
The English language is dominated by nouns – both the result and cause of understanding the world primarily through the lens of separation. We have a bias towards the parts.
Gestalt therapist, Malcolm Parlett, reminds us that the German language has a word for grasping the whole configuration of a situation: gestalt. ‘…to gestalt is an active verb (as well as a noun) – forming parts into wholes, sorting items into more complex and meaningful organisations of experience.’ ‘We are pattern-makers as well as pattern-finders.’ But often our patterns are too simple. It is easy to be blind! We miss the spaces in between.
Ian McGilchrist’s great book, The Master and His Emissary, identifies this tendency to concentrate on the parts and miss the spaces in between, with excessive dominance of the left cerebral hemisphere. The right hemisphere sees things whole, and in their context’ and ‘underwrites breadth and flexibility of attention’, whereas the left hemisphere sees things abstracted from context, and broken into parts, from which it then reconstructs a “whole”: something very different. In many spheres, particularly healthcare, we have become too reliant on the left hemisphere.
Left hemisphere dominance leads to understanding the world in terms of ‘linear causal thinking’ with its largely illusory need for control. It is a practical strategy for simplifying perception and decision-making, but when used excessively and inappropriately, it contributes to an enormous amount of anxiety and suffering for healthcare professionals. So entrenched is it in healthcare, that it almost seems to be the only way of understanding health and other sorts of problem for which over-simplified understandings are inadequate.
A woman walks into her doctor’s consulting room. She sits beside the desk and describes a pain in her belly. She puts her left hand around her middle and strokes with sideways movements as she speaks. Is it her appendix, or her stomach, or her large bowel? Or maybe a trapped nerve in her spine…. Is this the train of thought in the GP’s mind? Or is she listening intently to the words the patient uses to describe her pain? Is she noticing the hand, the stroking? Is she reading her posture? Is she wondering, why has she come now?
Systems thinking and complexity
There are ways of thinking that help us to become more balanced in our understandings, less baffled, more able to live with uncertainty and therefore less anxious. These ways can help us to see the world in an integrated (and therefore holistic way) so that we are not trapped within linear causal thinking.
There are various sorts of systems thinking: complexity is one of them. Below is a short extract from an easy-to-read essay on thinking systemically. Notice that this is not only about taking different perspectives, but integrating the world as a dynamic, ‘unfolding process’ – the so-called ‘divergent’ way of working with properties emerging from this unfolding reality.
For me, ‘systems thinking’ is a way of being. It involves a way of seeing or interpreting the world through thought and feeling. It is an attitude of open-ness, of inquiry, of looking from many perspectives, inner and outer, of holding, or trying to hold, an awareness of my own beliefs and assumptions, of noticing my reaction to things, of understanding the world as an unfolding process where everything is in relation to everything else.…. as if it were a mountain stream, bubbling along as a continuous, self-organising constantly-changing-but-staying-the-same process of unfolding…[and where] …emergent change will be welcomed… The attitude will be one of inquiry and experiment, of moving to next base and then reviewing.
Systems thinking – so what? My view of Systems Thinking, by Martin Sandbrook
Complexity
Complexity is a special kind of systems thinking. It is very good for natural systems such as human beings and human society, but also environmental issues. It provides us with both a theory and a language, giving the left hemisphere the wherewithal to appreciate the intuitive pattern-making that the right hemisphere does so naturally. Iain McGilchrist’s ‘Emissary’ (left hemisphere) might then be prepared to listen and cooperate with the ways of the ‘Master’ (right hemisphere) (see above). This is a coming-of-age story – our left hemispheres need to grow up and respect the intuition and wisdom emerging from our right hemisphere.
Below is a quotation from another short and easy-to-read essay, this time on Complexity Theory, which unpicks the way complexity conceptualises the underlying processes in nature.
“A non-linear or complexity-based approach … recognizes the bi-directional influence that is present in most relationships: A influences B and at the same time B influences A. Causality is bi-directional rather than unidirectional, and this changes everything. Over multiple cycles of these back and forth feedback interactions, the relationship between A and B takes on a number of important new properties….[This includes] minutely small differences or disturbances …culminating in transformational changes to the entire system…popularly referred to as the ‘Butterfly Effect’. …Complexity culminates in a quest for relation, reminding us to pay attention to our surroundings and our relationships. And that, to me, seems like a major contribution to improving well-being…”
Linearity, Complexity and Well-being by Anthony L Suchman (Professor of Medicine, University of Rochester, USA)
Integrated & Integrity in Healthcare
Most psychologists treat the mind as disembodied, a phenomenon with little or no connection to the physical body. Conversely, physicians treat the body with no regard to the mind or the emotions. But the body and mind are not separate, and we cannot treat one without the other.
Integrated in Healthcare
We can think about integration in relationship to the consultation or the healthcare system as a whole. With respect to the system it is clear to anyone working in this field that outcomes are better for patients and more satisfying for practitioners when services are integrated, when teams are communicating and working together and there are no gaps in services. The key to success is the quality of conversations between those whose actions impinge upon one another. If these conversations are real dialogue – listening and responding according to explicit values – then good outcomes will emerge from the system.
The King’s Fund updated their ‘Alternative Guide’ in 2017 – watch out for further updates.
Integrative Medicine
An ‘Integrative Medicine’ approach is one approach to ‘Whole Person Care’
Integrative medicine and health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.”
Integrity in Healthcare
Acting with integrity is an aspect of being integrated as a person. Integrity is a key virtue for healthcare practitioners but acting with integrity can be difficult to navigate.
Your professional integrity is a measure of the degree to which your own professional reputation and credibility remain intact. It is more than just clinical or technical excellence alone, since a major element of a person’s integrity derives from the way in which they are viewed by others. Anything which has the potential to reduce a professional person’s reputation in the eyes of another undermines their professional standing.
Resources
- Complex consultations and the ‘edge of chaos’
- Integrity – Stanford Encyclopaedia of Philosophy
- Linearity, Complexity and Well-being by Anthony L Suchman
- How does the NHS in England work? An alternative guide – The King’s Fund
- Meaningful Work: Rethinking Professional Ethics – book by Mike W. Martin
- A Flourishing Practice? – book by Peter Toon
- Future Sense: Five explorations of whole intelligence for a world that is waking up – book by Malcolm Parlett
The ingredients of both darkness and light are equally present in all of us,…The madness of this planet is largely a result of the human being’s difficulty in coming to virtuous balance with himself. ”
Elizabeth Gilbert (Eat, Pray, Love)
