Schizogenesis in Health Care Systems

The myths and dramatic dances of polarities remind us of a systems concept offered by Gregory Bateson (2000)—based on his observation as an anthropologist studying the dynamics of tribes operating in several parts of the world (mostly New Guinea).  He wrote of Schizogenesis—a term which refers to the tendency for two systems (organizations, tribes, nations) to polarize. They relate to one another in a manner that drives the two systems further apart from one another or that leads to escalation of similar activities in both systems.

One type of schismogensis is called Complementary, meaning that as one system goes in one direction, the other system goes in the opposite direction. For instance, as one tribe becomes more belligerent and active, the other tribe becomes more passive and withdrawn. We see this occurring in many health care systems, with the leader becoming more assertive and his employees becoming more compliant. Both parties are colluding in making the leader’s assertiveness justifiable and acceptable. This complementary form of polarization tends to be long-lasting, and it is deeply embedded, as a rule, in the culture of an organization.

The second type of schismogentic polarization identified by Bateson is called Symmetrical. As one system exhibits higher levels of a specific behavior, the other system will try to match this level. For instance, if one nation builds more rockets, then the rival nation will also have to build more rockets—the classic arms race. In a health care system, this symmetrical dynamic operates when both the leader and the employees tend to become more assertive (or more passively aggressive).

This symmetrical process of polarization is often what we mean by the “vicious circle.” It is characterized by exponential growth (the “power law” of contemporary chaos and complexity theorists) and will lead quickly to explosion and collapse. We typically, don’t find symmetrical polarization to be long-lasting in organizations. Rather, we are likely to witness escalation, collapse and then a renewal of the symmetrical polarization with new parties being invited to engage in this very dangerous and destructive dance.

One of us [WB] had the opportunity to spend time with Bateson and heard him speak of the great power that arises from schizogenetic polarization. It gains its power from the mythic properties associated with “reason[s]” for the polarization, conflict and accompanying judgements regarding the “virtue” and “rightness” of each tribe’s perspectives. As in the case of Eisenstein’s portrayal of the battle for one’s “homeland,” the schizogenetic polarization moves well beyond the realm of problem or even dilemma. Much as in the case of an avalanche or what complexity theorists call a “strange attractor,” resources are recruited to bolster each side of the split. A form of nuclear proliferation is engaged. There is no resolution because there is no communication between the two side. The conflict is ongoing. Wars are repeatedly waged. Lessons are rarely learned by either party. The death of ideals, visions and people is inevitable.