Complex Adaptive Systems in Health – Part 2 When More Isn’t Better: Supporting Change in Systems That Are Stuck

Complex Adaptive Systems in Health – Part 2

When More Isn’t Better: Supporting Change in Systems That Are Stuck

Intro & Recap (Bridging from Part 1)

In Part 1 of this series, we explored the concept of Complex Adaptive Systems (CAS)—systems made up of many interacting parts whose behavior can’t be fully understood by examining individual components in isolation. Like organisms, families, or healthcare organizations, these systems adapt, evolve, and self-organize in response to their environment. Their patterns emerge not through rigid, linear cause-and-effect, but through dynamic relationships and feedback loops.

We also introduced multilevel selection theory, a framework that helps explain how adaptation occurs across different layers—cells, individuals, teams, or entire institutions. This perspective sheds light on how a response that is beneficial at one level (like an individual strategy for coping) can have unintended consequences at another (such as strain within a relationship or system).

Finally, we revisited Engel’s Biopsychosocial model through a CAS lens, seeing the biological, psychological, and social not as separate domains, but as interwoven layers of adaptation that must coordinate to support sustainable change.

Now in Part 2, we turn our attention inward—to the human body and mind as a complex adaptive system. We’ll explore how maladaptive patterns often arise not from failure, but from intelligent adaptations to past contexts—and how clinicians can support lasting change by working with the processes that sustain those patterns.

Section 1: The Human Body as a Complex Adaptive System

Just like families, teams, and societies, the human body is a network of relationships—between systems, cells, signals, and stories. Our immune responses, stress patterns, hormonal cycles, and movement behaviors don’t operate in silos; they interact constantly in relational patterns that shape how we feel, function, and adapt.

And like any other CAS, the body can self-organize in ways that are highly adaptive in the short term—protecting function, conserving energy, or maintaining safety in a given context—but that same adaptation may eventually become constraining, misaligned, or even maladaptive in the long term.

A trauma response that shuts down emotional expression might protect someone in a threatening situation—but create chronic disconnection in safe environments. A motor pattern that avoids pain can preserve function temporarily but reinforce compensation and limitation over time. These aren’t “errors.” They are context-sensitive adaptations—solutions shaped by necessity.

In each of these cases, the system is doing exactly what it was shaped to do: respond to its environment in a way that preserves integrity. These are not failures of logic or will—they are survival strategies that made sense given the constraints of a particular moment in time.

But when the context shifts and the adaptation remains fixed, what was once helpful can become limiting. The nervous system may continue to signal threat where none exists. Movement strategies designed to avoid pain may generalize to other situations, increasing global tension or reducing variability. Over time, these patterns become embedded in feedback loops—reinforced through repetition, stress, or perceived threat—making them more automatic, more rigid, and harder to disrupt.

What begins as a protective response can crystallize into a stable attractor state—a default configuration the system returns to, even when it’s no longer functional. And because the body is a multi-layered system, these patterns don’t stay isolated. The nervous system, musculoskeletal system, and emotional-behavioral systems often align around sustaining these outdated solutions, reinforcing one another in subtle, self-protective ways.

As clinicians, it’s easy to treat these outcomes as isolated problems: the anxiety, the pain, the restricted range of motion. But when we recognize them as interconnected processes within a larger adaptive system, our role begins to shift—not toward correcting what’s “wrong,” but toward creating conditions that support the system’s capacity to reorganize itself.

And reorganization is, at its core, a relational process. Whether it’s between muscles and movement, beliefs and emotions, or people and their environments, change happens through the formation of new relationships. When the system is given safety, variability, and meaningful input, it doesn’t need to be forced—it begins to adapt on its own.

Section 2: When Clinical Routines Add to the Complexity

Even with the best of intentions, our clinical models often intervene at the wrong level of a complex adaptive system. Protocols, diagnostic frameworks, and treatment pathways can help organize care and reduce uncertainty—but they also carry the risk of overdefining a person’s experience. When we reduce someone to a set of labels or try to isolate one “primary” issue among many, we risk missing the relational nature of the patterns we’re trying to support.

A patient with fibromyalgia, irritable bowel syndrome, depression, and chronic low back pain does not necessarily have four separate problems. They may have a single, complex system that has adapted by organizing around protection, hypervigilance, or conservation of energy. These adaptations show up in different domains, but may be manifestations of a single underlying strategy.

When we treat each diagnosis as an isolated issue—each with its own medication, protocol, or therapy—we can unintentionally create more complexity for a system that is already overwhelmed. The system doesn’t need more input—it needs a shift in how it relates to itself.

And that shift won’t come from applying more control. In complex systems, the most powerful changes often happen when we target a key process, not when we chase every symptom. A change in breathing pattern might shift autonomic tone. A reframe of belief might open movement. A shift in relational safety might ripple across pain, emotion, and energy regulation.

This is where the clinical mindset must shift—from protocols to processes.

From Protocols to Processes

In healthcare, we are trained to reduce uncertainty—to name the problem, match it to a treatment, and move on. But complexity resists simplification. Especially in patients with multimorbidity, treating conditions in parallel rarely leads to integration. It fragments care—and often reinforces the belief that their body is broken in many places.

Instead, we can ask:

• What process is this system most organized around?
• What is it trying to protect?
• Where is there room for flexibility or re-engagement?
• What single shift might open the door to new relational patterns—internally or externally?

Sometimes, the most effective intervention is simply creating space for the system to reconnect with itself. This might mean shifting from strength training to safety-based movement, from cognitive strategies to relational co-regulation, from doing more to doing differently.

When we stop focusing on what’s “wrong” and start observing how the system is adapting, we become collaborators in the process of change—not enforcers of a treatment plan.

Restoring Relationship as the Mechanism of Change

In CAS, change happens through relationship—between signals, systems, behaviors, and people. Clinicians are not just technicians; we are part of the feedback loop. The tone of our voice, the assumptions in our questions, the structure of our care—these all influence how a person’s system organizes around safety, connection, and possibility.

Supporting reorganization means restoring new relationships—within the body, between mind and meaning, and within the clinical encounter itself.

We are not here to override complexity. We are here to work with it.

Section 3: Less is More – Leveraging Simplicity Within Complexity

In complex systems, more intervention doesn’t necessarily mean more impact. When a system is already overloaded—emotionally, neurologically, or metabolically—adding input can reinforce the very instability we’re trying to resolve.

Meaningful change often begins not with doing more, but with knowing where to begin. The goal isn’t to address every issue, but to identify the core process the system has organized itself around. That process could manifest in how someone moves, relates, feels, focuses, or acts. And while the entry point may vary, what matters is that it touches the system as a whole—because in complexity, even a small shift can create widespread change.

We can think of this as leveraging the system’s own intelligence. Complex adaptive systems don’t need to be micromanaged; they need the right conditions to reorganize. If we can identify a single thread—one meaningful, actionable change—that interacts with multiple levels of a person’s experience, we don’t just intervene locally. We open the possibility for global change.

And that doesn’t mean prescribing “the one right technique.” It means being curious about which relationships—within the body, with others, or with meaning—are holding the system in place, and gently interrupting those patterns in a way that invites new possibilities.

Working With, Not Against

When we stop chasing complexity and start recognizing where coherence is already trying to emerge, we begin to work with the grain of the system, not against it.

We might simplify the care plan, offering fewer tasks and more space to explore safely. We might swap compliance for co-creation, metrics for meaning.

This isn’t passive. It’s deeply strategic.

Because in a complex system, the smallest intentional shift—placed in the right relationship—can ripple across the entire network.

Conclusion: Supporting Change by Supporting Systems

When we understand the human being as a complex adaptive system, we stop seeing dysfunction as failure—and start seeing it as patterned adaptation that made sense in a different time, under different conditions. These patterns aren’t just stored in the body; they are held in relationships, shaped by feedback, and sustained across biological, cognitive, emotional, and social domains.

Clinicians are not outside that system—we’re part of it. The way we listen, intervene, and even conceptualize care influences the system’s capacity to reorganize. And the more we reduce complexity into diagnoses, protocols, and symptom silos, the more we risk reinforcing the very patterns we’re hoping to shift.

But when we recognize process over pathology, and support coherence over compliance, we begin to practice in alignment with how change actually happens. We stop chasing problems—and start restoring relationships.

In Part 3, we’ll zoom out to explore how the healthcare system itself functions as a complex adaptive system. We’ll examine how it often prioritizes adaptation for the system over the people within it, and how the very structures intended to deliver care can sometimes drive fragmentation, burnout, and rigidity. If we want to create systems that support life and learning, we’ll need to apply the same principles outward—beyond the individual—into the organizations and institutions that shape care at every level.