Monday 13 February 2017

Loss driven systems part 1: Cascading losses, and pain and fear.

I found a really nicely written New Yorker article, in which the author describes a rapidly cascading sequence of smallish personal losses: keys, bike lock, pickup truck, phone. It seemed like a run of bad luck, because as she tells it, the losses aren't interlinked. Her phrase is "And then, mystifyingly, everything fell out of place." 
I started wondering whether the first loss might have triggered the cascade in a non-obvious way. 
Had the brain's stress cascade partially shut down judgement to the point where the author was unable to protect against the next loss
Was it about divided attention: by putting her mind to remembering the bike lock, she forgot where she put her pickup truck? 
Or was it that the early losses derailed established habits, her confidence, or her schedule, and these habits were all that was protecting her life from the entropic pull of the universe? 

On cascading loss: the causal model, the complex causal model, and complexity

Consider musculoskeletal pain: a lower back muscular problem can trigger a spasm event which leads to all sorts of muscles doing all sorts of compensations that, if left to their own devices, cause issues throughout the body: shoulders, feet, fingers, scalp.. and conceivably migraines and jaw pain and sleep disruption too.
A consequential or causal loss cascade is easy to wrap one's head around. The story is a straightforward one.
Sore back -> didn't go to the barbeque and missed it -> didn't get included in the planning of the group camping trip. 

The next layer of linked systemic losses is the directly related, but not necessarily causal, cascade. 

But can a sore back trigger digestive problems?
Not if you're only looking at the musculoskeletal system. But in the body as a system, here is one possible clear causal cascade: chronic back pain is often treated with non-steroidal anti-inflammatory drugs, whose long-term use can be a trigger for severe gastrointestinal disorders. Sore back -> ibuprofen -> digestive problems.

Can a sore back trigger marital or professional problems?
This question requires stepping out of the body as a system, and into the system of the person-in-the-world.
Chronic pain is linked with mood disorders, but it's not clear that the link might be one-directional or bi-directional. Does the bad mood make you more susceptible to pain? Or the pain make you grouchy, anxious, depressed, or reclusive?
It's not such a big step to think that a mood disorder can impact one's partnership or professional collaborations. 
Now we start to get into the oft-underestimated interconnectedness of adjacent systems. A single adverse event (a back spasm) can clearly trigger losses in terms of more pain, drug side effects, and relationship impact. The person with the sore back may not have that particular cascade - but it's both possible and explicable that this could happen. Just because you won't find any papers in the medical or psych journals which allow causal linkages between a sore back and a divorce, doesn't mean they're not interrelated. You'd need to dig into the person's story to hear about their experience of the cascade. Or dig into the bulk statistical data to see if there is an overlap between people with back pain and people seeking relationship counselling.

Hobfall's Conservation of Resources theory

For humans and systems of humans, the framing of loss and gain of resources seems to be more important than the actual loss or gain. It doesn't matter what the loss is. Material or financial loss, loss of time, loss of status, loss of relationships, loss is loss.

Hobfall put forward a series of layered ideas in a few different papers (here's one of the key ones)that biological and psychological stress is a response to loss or anticipated lossResearchers have since measured how stress hormones (cortisol) goes up as people think about loss or experience subjective loss

In one of his more recent abstracts, there's one phrase which can be unpacked rather more deeply than has been done. The phrase is " ....the stress process within a more collectivist backdrop than was first posited...". 
It means that Conservation of Resources theory extends to how anticipated or actual subjective loss to a few of a group of organisms can neurochemically stress out the whole group. Whether in colonies of tubifex worms pulling away from a robot in a sewer, or in a team coming to terms with a round of redundancies and the anticipation of more.
Image result for hobfoll conservation of resources theory
Anticipated loss -> stress.
Loss to others -> stress to the whole system.
And in a loss-driven system, where the attention of the group is directed at the loss, individuals and the group work to adapt for, and protect against more loss. Not to seek, or even see, gains. 
"Don't go out foraging: roll the stone across the front of the burrow and stay put."

In the diagram at right, the dotted lines are really hard paths to take if all you expect to see is more loss.

And in the lack of seeing gains, the individuals and the system as a whole fails to pursue options for gain.
The point of Conservation of Resources is not the magnitude of the actual loss
It's the perception of loss. The anticipation of loss. Thinking about loss all the time. The neurochemical reaction to thinking about loss. And when losses cascade, this is particularly difficult, because you're caught in a mode of expecting more loss and it's really hard to put the last loss behind you and move on. 

Cascading losses is an observed pattern with a number of different pieces behind it. 

I read the New Yorker article and thought it interesting, and got on with my life. 
Then a few days later, I was held back ten minutes at work. I missed the deadline on a circuit book and I got a bit stressed. And I was surprised at how quickly fell into a multi-layered feedback-fed loss cascade, which included functional linkages, stress, attention, judgement, habit and timing.

To make the call that we were going to miss the deadline, I booked a late meeting to get everyone together, and I stuck around for 10 minutes longer than I should have. 
This lost me my window to travel in the pre-peak-hour traffic. 
When I did get out the door and to the exit of the parking lot, I fumbled the credit card payment, the machine went into an error state, and I lost another 5 minutes explaining it to the rocket surgeon on the intercom. Habit was disrupted. Judgement was a little shaky.
I knew I was going to be late to pick up the kids. I got stressed. Once the gates opened, I zipped off down the road, but I was careless with where I put my credit card at the petrol stop. I discovered the next day that I had lost it. Attention was on halting the loss of my time, not protecting my belongings.
I pulled over, rang ahead, and booked them into after-school-care. Unnecessary expenditure. More loss.
I had to pay quite a lot of careful attention to my driving: driving on automatic I tended to speed and tailgate. I had to pull over twice to take a phonecall, and sort out just-one-more-issue with the circuit book. I knew I was in a loss cascade and was trying to prevent more loss at that end. 
It was an hour after normal pickup time when I got to my kids. I was pretty tense, and I didn't want to infect them with the feeling of loss. 
I thought, I have to look for a small gain, a treat, something to get me out of the spiral and make sure I didn't pass it to them. I picked them up and took them straight to the beach.
At the beach, they played on the sandbar and the shallows while I sat on a towel taking calls from the project about what to do next. I used a bunch of techniques to contain and reframe the stress, and detach from the problem. I hid it from the kids, so by the time we got home, all was well. 

All because of being ten minutes late at the start of the cascade.

Even once I stabilised the stress of the immediate loss cascade, freezing and replacing the credit card triggered a functional cascade for the following week. The credit card is a key piece in our life system, and while there are contingencies and redundancies so we can keep life going normally, they are disruptive and there were still knock-on losses
I had to skip a fruit & veg box delivery and now have to go to the shop and pay cash. My tight work and family schedule normally relies on doing vegie shopping online in the evening. I had to cancel a few things, to make time to go to the supermarket - it cost me another publication deadline and a not-unimportant meeting.
There are things you can't buy without a credit card these days. I almost missed out on our eldest sitting a scholarship exam - it required payment online. I ended up borrowing someone else's credit card and paying them back in cash. 
A phone bill bounced. There's a penalty payment. Not much, but enough to irritate.
We've had to pack lunches rather than buy food from the downstairs cafe. They don't take cash anymore, just tap-and-go. 
With the new cards, we also have to go through all our regular direct debits and work out which to reinstate. We can either wait until they bounce, or spend a couple of hours with old bank statements and a highlighter.
It's been really annoying. 

Cascading losses can be more than annoying. Multi redundant complex systems like a body, or a family, or an infrastructure network, tend to compensate and compensate and compensate for losses, right up to the point where they catastrophically fail. Consider the octogenarian with osteoporosis, heart problems, diabetes, one functioning kidney, blindness and partial deafness, and an enlarged heart. She can be living independently at home, with everything managed and stable, until a slip or a fall triggers a very rapid decline. How does a fall exacerbate her kidney disease? No obvious causal link. It wouldn't have such an effect in a younger person. Only in the fragile elderly, where the redundancies are running out.

The issue is in how you frame and conceptualise cascading losses...

We generally think of cascading losses as either 'a run of bad luck', or in simple causal chains, which can be predicted with thought experiments or a simulation (such as a fire drill). Options can be evaluated and the best one chosen. Most of the safety, risk and mitigation structures I use professionally (and which we adapt to our personal life) use this kind of framing.

But cascading losses can also be multi-system causal chains or bi-directional feedback structures, where an event in one system (eg falling) may or may not trigger an apparently strange cascade of failures in other systems (kidneys, heart, diabetes etc). This kind of probabilistic assessment and mitigation is cognitively difficult. Most commonly, multi-system complex cascading losses are explained after the fact, rather than prepared prior. 


In cascading losses, there are a few common mechanisms, especially where human systems are involved.

Pain and fear is first on the list. Hobfoll's model uses the term 'stress'.

Pain is a topic worthy of its own post, but here's the short version. It's an ambiguous word to start with, and every person's experience is different. Pain is a huge and very costly problem in the world, in both human suffering and economically, and as a distinct thing from the multitude of ways it is caused and triggered. Pain in the body causes damage to the body. In fact, pain management is now a major focus of nursing, because the body's inflammatory and neurological pain responses often interfere with so many other body systems that medical outcomes from an injury or acute event are often substantially better if the patient feels no pain.
Outside the general medical ward, pain is not just bodily pain. 

There are a few models to help us think about pain which have quite nifty little diagrams: here's the neuromatrix model, Louis Gifford's Mature Organism Model, and the Onion skin model. What you'll quickly see is that these models all include 'beliefs' and 'culture' and 'past behaviours' and 'social communication' and such things. It's generally widely accepted that severe chronic pain and ideopathic (unexplained) pain generally have at least a psychological component, and very often a social or family history component too. There is a class of pain called somatic pain which has no traceable physical cause, but can cause extreme suffering and permanent disability. And amputees can have severe ghost-limb pain and spasm without even having the limb anymore.

Image result for neuromatrix model of pain

I'm going to make a sweeping generalisation: that fear is the feeling of anticipated future pain. 
Fear (we often call it anxiety) also causes a lot of human suffering and economic cost, There are anxiety clinics just like there are pain clinics, and the anxiety research overlaps with the pain research quite a lot (but without some of the creepier animal experiments). 

In any human cascading-loss situation, such as the author who lost her pickup truck in Portland, or my own credit card, or the octogenarian falling over, both pain and fear quickly come into the mix. 
The stress of a crisis often triggers an adrenaline surge, which compromises cognition and deliberate thought. You can no longer use your judgement to make decisions, because adrenaline triggers the brain to use heuristics - short cuts or habits - in order to respond faster to a crisis.
Perception is narrowed, making it easy to stop paying attention to small things which normally mitigate against loss (like keeping track of where your phone is). 
Fear and pain can distort your perception of time and urgency too - amplifying the perceived size of the loss in-the-moment and other tiny events. Things which are normally inconsequential (breaking a cup, tripping on the sidewalk) suddenly become catastrophic, and symbolic. 
People in pain or fear can experience the world as a malicious place, and they often lash out at others over trivial things, or nothing at all. Relationships and interactions with other people often become dangerous - and the person in pain can feel, or get, isolated very quickly.
Pain and fear are both exhausting, and fatigue reduces the activity you can actually do to mitigate the loss. Fatigue has very real knock-on effecst too, such as unsafe driving or compromised attention to whatever else you're doing. 
And both fear and pain can cause insomnia or disrupted sleep. Have I blogged on sleep yet? I think I may need to blog on sleep. 

So what stops a cascading loss situation?

Stop obsessing about the chain of loss itself. Pay more attention to your own pain and fear first.
Stop. 
Breathe. 
Deliberately try to relax.
Make a cup of tea.
Look for a small gain. A real gain, or a symbolic gain.
One tuned-in and skilled teacher can get a troublesome and troubled kid out of a loss cascade which would get her into juvenile detention, and academically flying.
One Ulysses butterfly - if it's symbolic enough - can be enough to get a broke, isolated and deeply depressed young man back to work.
One box of strawberries. One busker in the subway. One small victory at work, one story or joke with your family at home. 
Shopping doesn't count. It should count - because when you go shopping you come back with stuff, which should be a gain - but it's a financial loss, it crowds your space, and there's often guilt involved in buying un-needed things. 
However, sitting down for 10 minutes at the shopping centre and sharing a chocolate brownie and a conversation with a friend definitely counts. 

Only once you're feeling a little better should you identify, prioritise and start to sort out each step in the loss chain one at a time.

Reversing a loss cascade often takes a bit of time. But first you have to arrest the fall.

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