Difficult Choices and Unique Challenges

It is tempting to pretend that a warped plane of care, with many ridges and valleys of decision-making, is only a single pathway. No difficult decisions have to be made. Artificial clarity and simplicity are created. Unfortunately, when confronted with unique challenges and patients, one will often find that this clarity and simplicity collapse and the system suddenly falls into a chaotic state. Removing choice and oscillation between valleys may seem like a clever way to reduce unnecessary noise and variability. However, it reduces the ability of qualified experts to influence decisions and help navigate the oscillations between various pathways and valleys of care.

This expertise—and the processes of slow thinking—are needed in particular at a bi-furcating moment when there is the option of entering a new valley. There often is indecision regarding movement into the new valley. We have to make a difficult choice–unless we are automatically shoved into the new valley as a result of momentum. We will often “dither” between two options: the old valley and the new valley. Polarities are formed which provide unique challenges for those who are making decisions (Johnson, 1996). Each option is absolutely compelling—and absolutely unacceptable. This dynamic and the indecision of dithering is represented in the ancient fable of the donkey standing between two haystacks. The donkey moves toward one haystack and realizes that he is moving away from the other haystack. He then moves toward the second haystack and realizes that he is moving away from the first haystack. The donkey eventually starves to death having feasted on hay in neither stack. Swinging back and forth.

When faced with the bi-furcating prospect of entering a new valley, we swing—inside our own individual psyche as well as in our collective/societal arena. This dithering can be very damaging both physically and psychologically if sustained for an extended period of time. There is action but it is ineffective and ultimately powerless action. This scurrying back and forth is much like what occurs among small marsupials on the African savannah when they are faced with making a choice about escaping a threatening entity such as a lion. All too-often the scurry can gain the attention of the lion and the marsupial can easily get devoured. As human beings we are similarly vulnerable when we are engaged in this kind of mind-less, fast-thinking action. Scurrying back and forth is oscillation—permanent oscillation can become a frozen-like state.

More generally, we can define this condition of oscillation as a matter of finding two or more options to be viable. We can run from the lion, freeze in place, or even wack the lion with a stick or the spear we are carrying. What do we do?  The noted philosopher, Richard Rorty (1989) observes that a very painful condition that he called Irony is prevalent when we must simultaneously address two or more contradictory options. We can fight, flee or freeze when confronted with a real or imagined lion and we can choose between two stacks of hay (alternative opportunities for achievement). We may swing back and forth–creating a state of what Ralph Stacey (1996) identifies as Anarchy (see our previous essay: Fish and Bergquist, 2023). Instead, we can remain in thoughtful consideration of each option before moving to the second option. While this requires that we acknowledge (and even help to create and sustain) a state of complexity, there is also the possibility that we will make an appropriate choice. At some point, we do decide to enter the new valley or find a way to remain in (and improve functioning in) the old valley.