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Thoughts on Models, Nihilism, Safe Spaces, and Boundaries

Complexity theory is not nihilism. The whole may not be the sum of its parts and the interactions between the constituent elements of a system, though difficult to quantify empirically, profoundly affect behavior.  When connections are overemphasized, however, it can be difficult to act with meaningful intent in a field like medicine.  In complex systems, boundaries, even arbitrary ones, are necessary to maintain a semblance of order. Biological, ideological, and theoretical extremes are maladaptive because they are typically overly rigid or overly chaotic.  Asystole (no electrical activity) and ventricular fibrillation (completely disorganized electrical activity) are both lethal heart rhythms. When it comes to security, we want to be safe from those who wish to do us harm but not at the complete expense of civil liberties.  We want to right social and legislative wrongs for historically marginalized groups without disempowering them by assuming they have no agency or free will.  In each of these instances, the real conversation should be about what constitutes “reasonable” boundaries; not debating the merits of a police state compared to one with no security apparatus, as an example.

Conversations about boundaries force us to revisit timeless philosophical questions that have no simple answers.  This is why the “safe space” phenomenon is so anti-intellectual and toxic to educational institutions.  Safe spaces are not a prerequisite for civility and tolerance.  Theoretical boundaries and ideas should never be safe.  Reformulating boundaries is necessary for progress even when the process is contentious. The alternative, the absence of nuance and a delusional sense of certainty, is worse.  Politics and religion deeply influence the trajectory of humanity yet “don’t talk about politics or religion” is a typical conversational default. Effectively we’re saying that we should avoid talking about the things that are most consequential to our collective predicament.  We’re afraid to talk about boundaries so we bloviate about who wore what to an awards ceremony for entertainers instead.  To be clear, conversing about political and legislative boundaries does not preclude an appreciation for entertainment but our attentional focus seems skewed towards the latter.

Humans are complex systems.  Human movement is a complex phenomenon.  “Ideal” movement is a problematic construct because the system’s constraints are dynamic and non-linear.  That there is no ideal doesn’t mean that some solutions aren’t preferable to others, however.  Hence complexity does not say that we can’t make generalizations about things like foot strike patterns in running or lumbar position under load.  The manner in which a system self-organizes (e.g. an athlete’s “natural” running or lifting technique) is not necessarily reflective of a sound strategy nor does evolutionary theory proclaim that any behavior exhibited by a surviving organism is adaptive.  Humans can survive in spite of their behavior so not every emergent solution in a surviving species is “worthy” of being passed on to future generations through genes and/or culture. Evolution just says that in response to a confluence of competing variables/demands, we’re left with different package deals.  Not every aspect of each package is beneficial.  The package, in its totality, is “good enough” though by virtue of the fact that it’s here- for now.

Moreover, blind faith in self-organization assumes that sufficient variability or options are available from which solutions can be derived.  Perhaps the system would better self organize if there were more choices.  Sometimes the solution we observe to a movement related problem is guided by necessity and limited choice, not so much self-organization.  In other words, emergent movement isn’t always the victor of some subconscious cost/benefit analysis or “choice”.  Some people don’t have movement options available to them secondary to things like guarding from pain, motor control limitations, mobility restrictions, or lack of familiarity with a particular option. Self-organization works better when there are real choices.  The external environment might create constraints that render certain options unusable.  Nevertheless, an alphabet of available movement options, provided the number of options isn’t completely overwhelming (chaos), allows for more effective strategies to emerge from self-organization.  Movement nihilism is no more explanatory than movement idealism.  Just as it’s inaccurate to suggest that there is an ideal way to move even under a particular set of constraints, it’s also fallacious to assume that the manner in which movement self organizes is always the ideal solution.

Complex systems still benefit from models.  While a “neutral spine”, as an example, is a theoretical fantasy, the construct reminds us to avoid heavy loading at end ranges.  This information is helpful when trying to maximize performance (not predict pain so please don’t bombard my feed with pain studies) during certain movements despite the fact that the spine, unlike a transmission, is never in “neutral”.  The advancement of knowledge occurs by creating models and continually refining them, discarding them, or starting anew. All models are “wrong” but many of them are still useful. Recognizing the limitations of the neutral spine paradigm (e.g. that “neutrality” is not an absolute standard that can be satisfactorily defined and measured) does not render the entire model unusable nor is the model necessarily an endorsement that the spine is vulnerable or unstable.

Sometimes theoretical models inform boundaries within a complex system when empirical models cannot, even if the latter models are preferred. Completely rejecting the “neutral” spine construct, in this instance, means advocating repeated heavy spinal loading at end ranges which, to be clear, is not the same as rounding one’s back to pick a dust bunny off the floor. Promoting movement nihilism and fervent belief in self-organization is evasion of professional responsibility. Models and conceptual frameworks serve as maps that guide us toward solutions to complex problems.  Maps don’t take us to our destination.  We still need to think when navigating with a map but we’re usually better off with a decent map/model than without one.  If we reject all models we’re no different than Comic Book Guy from the Simpsons and every attempt to explain reality is the “worst thing ever”.

Without models, even things like controlled trials in medicine aren’t very useful since we’d have to reformulate a clinical reasoning process with each new patient encounter.  Instead, we (hopefully) use general data from controlled trials within a particular model to make individual encounters are more manageable. Controlled trials don’t prohibit us from recognizing context, which studies often dismiss as noise out of necessity.  If we just dismiss each situation as completely unique it becomes very difficult to have any professional conversation though.  Models are informed by patterns and patterning is an emergent property of complex systems. A medical world without theoretical models is like a society without laws.  Laws don’t ensure that people will act ethically and ethical behavior can emerge or self organize without laws.  Laws manage expectations much like grammatical rules manage the acquisition of language.  While we still need courts to opine on controversial cases, without laws everything that currently constitutes a legal infraction would become its own ethics discussion, which isn’t desirable when time is an influential constraint.  Controlled trials and the basic sciences help establish “reasonable”, albeit somewhat fluid boundaries for individual patient encounters.  Medicine needs models because the body is so complex.  These models just aren’t stagnant.