Humberto Maturana, Francisca Varella and Heinz Von Foerster are all dead now. And I really thought their whimsical inquiry around human cognition may have died with them. And then I read this paper

It starts by saying ’Cognitive science is itself a cognitive activity. Yet, computational cognitive science tools are seldom used to study (limits of) cognitive scientists’ thinking.” ……I stopped reading here to check the authors and publication date, but it is recent and it wasn’t Heinz!!!! Feeling a little excited I read on….. ” Here, we do so using computational-level modeling and complexity analysis. We present an idealized formal model of a core inference problem faced by cognitive scientists: Given observations of a system’s behaviors, infer cognitive processes that could plausibly produce the behavior. We consider variants of this problem at different levels of explanation and prove that at each level, the inference problem is intractable, or even uncomputable. We discuss the implications for cognitive science.”

I haven’t read anything so wonderful since Heinz died in 2002. Granted I may have been looking in the wrong places and I thank the pandemic for revealing the nonsense in those places.

One of the really helpful things that Heinz spoke about was the difference between a trivial and a non trivial machine. “The trivial machine is all the rage among the followers of the notion of causality” he said in his conversations with Bernhard Poerksen.

The precondition for speaking about a cause and effect relationship, is that the rule of transformation is known. You have to know what makes the cause become the effect. In a simple machine there is an unconditional and unchangeable relationship between the input and output.

In medicine we have tried to turn snippets of the vast complexity of the non-trivial machine that is the human body into trivial sub unit machines. We have diagnoses that can be thought of as trivial machines and they are actually handled by doctors as if they are trivial machines. For example, diabetes can be diagnosed by a fasting blood glucose level. Above a certain reading it is diagnosed definitively, below a certain reading it can be excluded definitively and in between there’s another whole new world to turn glucose intolerance and insulin resistance into a trivial machine. The more unchangeable we make the relationship between treatment and effect the better the medicine.

It is such a satisfying field to work in if you like certainty and tidiness.

And so boring if you like uncertainty and messiness.

The medicalisation of human suffering has tried to follow the same path and as Heinz might say, it really is a horror show.

This lovely paper unpacks the horror and fictionally removes it and then, just as Heinz was prone to do, although possibly borrowed from Gregory Bateson’s metalogues, the authors use a fictional dialogue to explain what they mean. I’ll paste the metalogue herefor those who want the short version of the good bits of this lovely paper…….

“Unpacking the full implications of our results for cognitive science research practice is not easy, and we imagine that those reading this may have all kinds of questions, objections, or counter-intuitions. Given space limitations, we cannot possibly address them all. Instead, we unpack the implications of the results using a fictive dialogue, addressing the most likely concerns along the way. In the dialogue, Dr. Conjectura (denoted by C) plays the role of the skeptic who does not see the relevance of the results for their own practices. R relays our responses.
C: I appreciate you trying to help me achieve my research goals, but I can’t see how you are doing so. How are the theorems relevant to me? I am never in that ideal situation.
R: What ideal situation?
C: You formalized my inferential problems by assuming I have perfect, errorless observations. But my data are always incomplete and noisy.
R: The theorems show that in the ideal situation finding explanations consistent with the facts is not tractable. How can more uncertainty about the relevant facts make this problem easier? It seems it can only make it harder.
C: Fair. But you set an unrealistic standard for explanation. No explanation is perfect, but at best an approximation.
R: What do you mean exactly by ‘approximation’?
C: Well, for instance, explanations do not always need to be
consistent with all the data.
R: We need not assume such a high standard. Even if an explanation needs to be consistent with, say, half of the data,5 generating such ‘half-consistent’ explanations remains intractable.
C: Oh. That’s counter-intuitive.
R: I hope this takes away your worries about the idealizations we introduced? In general, many problems that are intractable to solve exactly are also hard to solve approximately, for various meanings of ‘approximation.’6
C: But I still do not understand. If you would just give me perfect, error-free observations, shouldn’t it be easy for me to infer the mechanism producing that data?
R: Explanation does not come for free. The number of possible mechanisms you could describe with language and mathematics is astronomical. Finding a description that pinpoints a mechanism consistent with the data is like finding a needle in a haystack: there exists no general efficient procedure for searching the space.
C: But I’ve already narrowed down the options. I’m looking only for explanations of a particular cognitive architecture type: [insert your favorite framework, e.g., ACT-R, Adaptive Toolbox, PDP, Subsumption-Architecture, etc.].
R: Our analyses encompass this view, as one option, by constraining the space of possible functions (the set F ) and algorithms (A), according to your architectural commit- ments. Even with such general a priori commitments, the space remains astronomically large for architectures with non-trivial computing power.
C: What do you mean by non-trivial?

R: Well, even if a system has few possible internal states and its behavior is fully governed by simple rules, generating explanations of its behaviors remains intractable.7 you think that human cognition is simpler than this?

C: No, likely more complex.
R: Then our intractability results apply to your work.
C: Are you saying my work is hopeless? I cannot hope to ever generate a satisfactory explanation for cognition?
R: I wouldn’t say hopeless. If you were to hit upon a satisfactory explanation through sheer luck, then you could recognize this.8
C: Sigh. That’s not much of a plan …
R: I don’t think you need to be any more discouraged by intractability than by the inherent uncertainty in your data, generalizations, and theory that you were already dealing with. But it does mean that your inferential work cannot be proceduralized in any efficient way. So best not try to make an algorithm, or an otherwise too-strict set of rules, to replace your scientific thinking.
C: Why not? What could go wrong?
R: You may fool yourself into thinking you are searching the whole space, while you are actually stuck in a small corner of an astronomical space outside your considera- tion. It may also cause you to assume that the system you are studying is simpler than you really believe, because otherwise your procedures would not converge efficiently.
C: Well if any procedure I might use will hold me back, what can I do?
R: I would endorse a meta-approach of not proceduraliz- ing. This is especially important now, as we increasingly focus on a too narrow set of methodological approaches in cognitive science.9 The best advice I can give pertains to the community: our only hope of understanding the mind is if the community allows for pluralism10 in approaches and an unbounded number of procedures different researchers may adopt.
C: Why unbounded?
R: Because it is known that intractable problems cannot
be solved by a fixed number of parallel procedures.11
C: But if we impose no limit on the number of approaches,
wouldn’t there be many bad ones?

R: Recognizing the need for and legitimacy of alternative approaches is a prerequisite to productive critique.12 So you can critique approaches on substantive grounds, but I must dissuade you from viewing any fixed (set of) proce- dure(s) as the right one and trying to convince others that they should adopt it too. I’ve noticed you grumbling about the too-subjective methods13 some of your colleagues are using, and I must encourage you to live and let live.14

……..And so, I humbly strive to live and let live……..

Public health is all about managing the health of a population. The driving forces are really not intended to manage an individual’s health.

Individual health management is tailored to the individual but almost never translatable to managing a healthy population.

If you think about the last time you went to the doctor and were prescribed a treatment, you understand that it would be very strange to say ”that treatment was good for me so the whole population should have it”.

Well orchestrated lockdowns during the early stages of the Covid pandemic successfully reduced the the death toll in Australia. We had a negative “excess death rate” for 2020 and 2021. That is a fantastic public health outcome. However the wellbeing of some individuals was actually negatively impacted by lockdowns. It was a great decision for the population and turned out to be a really bad thing for some individuals.

Getting your head around how public health and individual health priorities are different and often collide turned out to be very hard for people during the pandemic and fuelled most of the social unrest that we saw.

With Public Health initiatives it is expected that a small percentage of individuals will opt out or will be unsuitable due to their individual health requirements, but Public Health initiatives do not need 100% compliance to work.

I suspect that there are many systems that this collision of priorities creates unrest.

As many of you know I co-founded a Neonatal Kitten Rescue Hobart. We rescue tiny kittens who are unable to feed themselves. These vulnerable waifs and their stories have amassed a big following and a small army of supporters. The not for profit is financially sound and the work which is all done by volunteers is highly regarded.

But, the cat is classed as an invasive species in Tasmania. Despite 200 years of integration into the Tasmanian eco system it is still demonised by many, and mass cullings are randomly undertaken despite poor evidence that such actions will achieve anything.

Rescue is an individual welfare issue and the Tasmanian ecosystem is a population issue and the forces commonly collide. There are also lots of factional groups competing on the interest of one species over another. I have recently discovered that the Sugar Glider, while native to Australia is introduced into Tasmania and is decimating the swift parrot population be eating nestlings and their mothers as they sit on eggs. Culling cats increases sugar gliders and decreases swift parrot females, which are usually monogamous but are now having extra marital affairs due to the excess of males. It is complicated.

The muddied water that is mental health policy is a similar area where competing forces have had bad consequences. We have seen interventions driven by population data impact terribly on individual mental health time and time again. The cashless debit card is the most recent train wreck here in Australia.

The right intervention for an individual many times takes them out of the workforce which is bad for the population. Theres a book called “Sedated: How modern capitalism created our mental health crisis” which looks at this issue of tying work productivity to DSM categories. What can seem like an innocent distinction for the clinician to make is painted in a new light as a noxious force in the capitalist machine.

Clinicians see daily how interventions that work with individuals are just not translatable to the masses. The idea that they might translate fuelled 60 years of stagnation in the field of psychotherapy. Many therapists with skills in marketing and good intentions ran with their personal discovery from working with a few clients, a new technique that they thought would work for the masses. Lots of TED talks were had, keynotes and conference tours with no improvement in outcomes in population mental health and possibly even more alienation of the poorer socio-economic cohorts who suffer the most.

The clinicians that I admire rose a little on that wave and didn’t like what they saw, choosing to return to the basics of foundational teaching and focusing on doing good work in the full awareness that there is something seriously missing in the field but until we find it we can focus on doing good work with individuals and working on being available to the more disenfranchised cohorts.

There is something very humbling about working in a time that we will look back on as a profession with embarrassment. We know we will look back with shame on things like human rights violations of psychiatric inpatients, on medicating children without knowing what the drugs we use actually do on many systems. On receptors that we know exist outside the brain but we have little understanding of what they do there. And yet doctors still prescribe.

SSRI product information contains a warning that the drug increases suicide risk in under 25’s. It has had this warning for my whole career and prescriptions continue to be written and under 25’s on SSRI’s continue to suicide. And yet doctors continue to prescribe.

Neuroscience, the golden child of the ’90’s has also not delivered. We could say it’s in it’s infancy, but after 30 years of intense study and no improvement in outcomes for people, it is more likely that its basic fundaments are flawed. The observations are very gross. For me its like saying ohhh you went to the gym and did arm curls and now you have big biceps. The big biceps must have made you go to the gym and do arm curls. You must have had a genetic predisposition in your biceps that predispose you to go to the gym. I read any neuroscientific observation through that lens to help keep things real. There are way too many dodgy semantic links between two observations being made.

So why the meandering on this sunny winters morning in Tasmania, 42 degrees South, when I haven’t written a blog for so long? There isn’t enough written on how badly we are doing with mental health. Theres not enough gentle questioning of the foundations we take for granted that must actually be flawed for such monumental inaction to have been the norm. Gandhi said a long time ago that you can’t change anything without a newspaper, I am a fan of conversations for possible conversations. we don’t know what we don’t know.

For me, I think management of suffering has been too much in isolation for the last century. Healing always used to happen in community. In large group rituals. Making it a one on one thing in a clinician’s consult room was such an odd thing to do.

It has been a long time since Ive written a blog. These blogs were originally an enthusiastic exploration in an attempt to improve my work and teaching in management of mental health in General Practice. It turned into largely disillusionment about the mainstream direction of mental health care.

So often there’s a family in crisis and lots of government departments involved wanting employment, training, school attendance as outcomes… but the family doesn’t have stable accommodation. They dont have an income to pay their bills, they have an ever present threat of retribution for non compliance, and commonly other threats in the form of court orders and family violence. How does one think about completing a school assignment with all that going on? Children experience a world of disconnect and that the system doesn’t care. How does a stretched, stressed, usually single parent provide for the needs of such children when to do so risks their only source of income.

So much money is spent by this system, but never where it is needed. Ive seen these families do well when stimulus packages and cash payments relieve their stress. I saw it in the GFC and through the covid lockdown. Something must be wrong when relieving financial stress and bringing some equality through an external impact on the wealthy, makes such a difference to the people who are really suffering.

And we never look at these things that work and say to ourselves “maybe we should do more of that”

In our work with clients I think it’s the same. Something makes a difference and instead of doing more of that with this client, and being attuned to the things with each individual client, we turn our single success into a new theory and ram it down ther throats of all our clients. Just look at who is on the current lecture circuit doing just that. That’s what the system does too and it causes damage.

So I have a few proclamations from my 30 years as a doctor and from my General Practice which has specialised in mental health.

A good mental health practitioner is good with a diverse population of clients and is invested in the clients that they seem to make worse. They build strong relationships and most importantly they care. They admit their mistakes and they can apologise if their ideas caused hurt. They dont claim to have the answer. They never blame their client. They dont give up on people. They aren’t wedded to theories and they discredit unhelpful theories that clients have picked up from the broken infrastructure that have caused suffering and disempowerment.

I believe that we will look back in 100 years at our theories on mental ill health and be embarrassed. Like so many generations before us we will see that our constructs and explanations damaged people.

I value scientific exploration. But true science explores the phenomenon to be explained and if the explanation doesnt fit it is thrown out. We dont bend people to our explanataions, we must change our explanations…or better still, don’t have any explanations…at least for the next 100 years!

“I don’t believe just ‘cos ideas are tenacious it means they are worthy” Tim Minchin

I haven’t written a blog for a while. I came to a standstill in the exploration of excellence in the field of therapy and went on a kind of experiential sabbatical. I think I came to the conclusion that the current paradigm would work if it wasn’t for the people. A bit like the old saying that the operation was a success, but the patient died. People also say that hospitals and schools would run smoothly if you did away with patients and students.

I thought it might be useful to look at the problem of mental illness culturally, since looking at it medically didn’t get us anywhere… and by that I simply mean that there is no evidence that we have improved outcomes for people since the medical profession took on he task of treating emotional suffering after the Second World War.

Returning to the topic of cultural change takes me back to hang out with some splendid explorers. The ones I like are Humberto Maturana, and the others who came out of Chile’s turmoil with a fascination in ontology, Heinz Von Foerster and his connections with the Macey conferences and beyond, and then the greats who have created it without necessarily talking about it intellectually like Nelson Mandela, Mahatma Gandhi and Desmond Tutu. 

Humberto Maturana was interviewed by Bernhard Poerksen to create the lovely book “From Being to Doing” In it he spoke about his time in Chile after the coup where Pinochet assassinated Allende and the country was thrown into tyranny. Everyone who was able, tried to get out while they still could, including Maturana whose friend Heinz Von Foerster scrambled to get him a University post in North America so that he and his family could escape. 

In the ten days or so that it took for a position to be secured Humberto had watched as all the free thinkers and movers and shakers fled the country. As a University lecturer he found himself wondering what would happen to the young people, to his students, and what would happen to democracy if all the democratically minded people left.

He had in the past been fascinated by the stories that his friend Heinz told about cultural change that happened in Nazi Germany, of which Heinz had personal experience. In those phenomena that shocked the free world, including that there were good people who actually didn’t know what was happening and were upholding and supporting the regime that was perpetrating atrocities. How did that blindness get created? 

Maturana was beginning to see how. Curfews were being imposed and people disappeared under cover of night. Plausible stories of cover up and some sense that things must be happening for a greater good because the country was still functioning began breathe life into a bizarre unreality.

He decided to stay.

One of the many things I admire about him was his ability to maintain his dignity in the face of potential oppression. Here is a chilling example:

He and a hundred or more other University academics were invited to dine at the palace with Pinochet. History did not build confidence in situations where large groups of people were rounded up by dictators and many of them feared for their lives. 

Pinochet gave a toast to the fatherland and they sat down to a delicious meal. Before dessert was served Pinochet stood again from his seat where only a few meters away Maturana heard him say “Ladies and gentlemen, the sole purpose of this meeting is to get to know each another. That is all. You may feel quite safe; there will be no demands on you of any kind.” 

He sat down again and Maturana then picked up his glass and stood and said “Ladies and gentlemen, I would also like to toast our fatherland with you. We are gathered here today in the company of the president, and that is a rare occasion under any government. I will therefore seize the opportunity and bring out a toast with you and the president to the effect that we all who are here today contribute to the intellectual freedom and cultural autonomy of our country, Chile”

Now you can imagine the terror in that room as he spoke, but Maturana understood that power only exists where their is obedience. By standing with dignity and preserving his autonomy he helped to restore the dignity of everyone in the room. Pinochet clapped his hands together three times and the room exhaled. Later, in the mingling, Maturana was urged to approach Pinochet who shook his hand and said “I share your good wishes for this country”

Take another moment to share Maturana’s reflection: “It really was a bizarre situation”

Twenty or so years ago, we began seeing a cultural shift in government departments in Australia that had trickled down from some big shifts in leadership. Books were written like “Tampering with the Asylum” and there was enough political commentary for most people to see that something fishy was going on. It wasn’t yet so mainstream that you couldn’t stand up and call out acts of tyranny, and a common analogy of the day was that of the Emperor’s New Clothes. Back then you could be the little boy who stood up and said “But the Emperor is naked”

Not long after this a colleague said “Yes, but the world isn’t kind to the little boy who says that”

That comment has stuck with me as I have watched in government departments as piles of such little boys (and girls) are chewed up and spat out, and we are now seeing this spread from government department to private industry and to schools.

I no longer use the “Emperor’s New Clothes” analogy, as it’s too dangerous, and have moved through the “moving the deck chairs on the Titanic” analogy and am more and more seeing people drowning and flailing in the water in these organizations.

The Fat Man in “The House of God” instructed his hospital Interns: In any emergency, take your own pulse first. Or, said another way, when the oxygen masks fall in the plane, fit your own mask before helping others. If you’ve ever tried to help someone who thinks they are drowning you have likely experienced that the flailing force of their grasp to be saved can be life threatening for you.

I used to think that people higher up in the organisation should know better and have a responsibility to the person under them. It might be true, but it isn’t useful to have that expectation if nothing comes of it. I began to think instead that they were under the influence, like the good people in Germany who fought for Hitlers regime believing that it was right. I often shared stories with people who were damaged by such treatment, of the denazification programs that happened after the war that helped those good people grapple with the terrible things they had done. This reframe helped to make the damage seem more cultural than personal, which sometimes helped the pain. 

More and more, though, I am seeing that those people doing the damage are just drowning too.

Erickson was asked to see a patient in a mental institution around the middle of last century. The man kept saying “I shouldn’t be here” he said this over and over, even in response to attempts to help him. Erickson simply walked up to him and said “But you are here” to which the man replied something like “Oh shit, how do I get out”

I see so many people grappling with injustices in our present day culture, and I do so myself, all the while saying “It shouldn’t be like this”

“But it is like this”

Oh shit…..