Does SF treat mental illness as complicated or complex?

The pandemic has brought the topic of mental illness – and its close but not opposite cousin mental health – up the agenda.  There is no doubt that living in lockdown can be very tough. But how might we think about making things better?

Some of my longer-standing readers may recall that I have always been interested in the science of complexity – the way that things emerge unpredictably where looping connections, recursive relations come into play. I did my PhD in the early 1980s into the ways that hydrogen atoms can self-organise, in a complex way, within metal lattices.  So when complexity started to appear in the fields of economics, innovation and organisations in the early 1990s, I was immediately interested. Here was not only an explanation for the lack of success of more ‘mechanical’ ways to understand people, it was also a new way to think about how to tackle confusing and tough situations. 

I started writing about complexity in management for the Strategic Planning Society journal Long Range Planning (the title gives away how little they cared for the topic of in-built uncertainty!) in 1996.  In 1998 I was invited by Dan Ciuriak (on behalf of committee chair Janet Yellen – look what happened to her!) to submit a paper to an Asia Pacific Economic Cooperation conference on lessons from complexity when examining the Asian Financial crisis of 1997. And all the while I was learning about solution-focused (SF) practice and being struck by how well it fitted with a complexity lens.

When The Solutions Focus book was published in 2002, Paul Z Jackson and I attempted to bring emergence into the picture, initially as a riposte to the influence of Peter Senge and system dynamics (popularised in his book The Fifth Discipline).  I then spent a decade or so attempting to interest SF people in complexity (with some modest success) and to interest complexity people in SF (with nearly no success at all). All this was in the broad context of tackling things as simple/complicated/complex/chaotic.

In around 1999 Dave Snowden coined the term ‘Cynefin’ (the Welsh word for habitat) for the simple/complicated/complex/chaotic framework. He has since been developing it, speaking about it, teaching it and using it, and has gained quite a following.  My good friend Chris Corrigan wrote a very nice blog about the 2020 iteration of Cynefin which is well worth reading.  The framework (see the picture alongside) has expanded to five, possibly seven domains, with considerable attention now given to the boundaries and edges between the original domains. The framework is offered as a way to think about an actual situation and to consider which (if any) of the domains it might be located within.  The fifth domain is the central one, entitled ‘confusion’ (where you’re not sure).  It inspired me to revisit the question of SF, complicated and complexity.

The ‘complicated’ domain is one of the two ordered domains.  This means that in general things there are knowable, understandably by analysis and experience, and best worked with by finding people who know what they are doing in this arena.  So, if you want to engineer an airliner or work a Zoom meeting, find people who know about it and follow their advice. Within this domain lies the diagnostic approach; work out what kind of problem this is and then do what people do to solve the problem.  This is all very well when working a Zoom meeting, and also works broadly well in the medical field.  However in the field of mental illness it is (to my mind) more problematic. The Diagnostic and Statistical Manual has grown bigger and bigger over its five major revisions since 1952, with ever-growing extent (130 pages growing to 991) and numbers of disorders (up from 108 to 354). This growth in disorders is not, sadly, reflected in increased efficiency in dealing with them.   

The ‘complex’ domain, on the other hand, is one of the unordered domains.  This means a radically different approach is required; looking at the particular situation rather than trying to generalise it (as one would in the complicated domain), inviting people to be creative while living in the broad constraints of their form of life (so they can be happier, but not eighteen feet tall), and trying small things (‘probe’, in the Cynefin words) to see what happens and learn about this situation, and then proceed with greater know-how. It is even recommended that while working in this area “Don’t worry about collecting tons of information before acting: it won’t help you past a certain point.” (quoting from Chris Corrigan’s summary).

So: is mental illness to be treated as complicated or complex? These are two different ways to look.  Those who choose the complicated route are, in my experience, often those with a lot of training and experience of working like that. Some may be doctors who are comfortable with prescribing drugs, others may be practitioners who enjoy the comfort of feeling that they know more about their clients’ experience than the clients themselves.  In choosing an SF perspective we have already chosen the complex route.  That this is more effective and efficient as well as ethical and respectful, energising and elegant is a bonus. 

My new book The Next Generation of Solution Focused Practice (Routledge, 2021) unpacks this in more detail. I look not only at how SF work achieves these ‘5 E’s’, but also how we can have a robust theory about what we do which shows why we need to focus on the clients and their language, not distracts us from them. And I explore how, in the end, choosing an SF stance may be an aesthetic choice as much as a practical or scientific one.  The book has been nearly thirty years in the writing – I am delighted it won’t take as long as that to read!

The Next Generation of Solution Focused Practice by Mark McKergow is published by Routledge on Tuesday 13^th April 2021.  Available through all the usual channel and also in Kindle format. You can probably pre-order it at a reduced price on Amazon UK.