How do systems work?

One of the obstacles to satisfying and fulfilling functioning is the lack of understanding of how systems work. Most of the systems that comprise modern life are complicated and thus confusing, frustrating, anxiety inducing, and can seem overwhelming. As a Psychiatric Social Worker I spend a lot of effort and energy in helping clients navigate the various systems that can provide the resources for them to meet their needs and are requiring some degree of compliance, cooperation, and behavior. This assistance requires that the Psychiatric Social Worker understands how these systems work. This understanding requires education and experience. This understanding of how systems work is a major component of Social Work competence.

The assistance in navigating systems is sometimes referred to as “empowerment.” Empowerment involves three activities: providing information, teaching skills, and providing opportunities to use that information and those skills.

What are the major systems that people function within in our current society? Some of them are education, health, legal, economic, recreational, media, social welfare, and political. Within these domains there are multiple subsystems.

Here on Markham’s Behavioral Health we will be exploring how these various systems work and how they can best be navigated to obtain what resources they provide to improve a person and their family’s functioning.

The overarching question is how do these systems affect a person and community’s mental health?

Michel Foucault called these systems “discourses.” Discourse analysis involves several components of the discourse: knowledge, skills, values, expert representatives of the discourse. One of Foucault’s great contributions was to analyze discourses historically and trace their development in society over time usually involving a couple of centuries or more. Understanding discourse development historically gives the student a better understanding of how the discourse’s knowledge, skills, values, and expertise evolved and came to be what they are today.

The first discourse to be described on Markham’s Behavioral Health is the health care system in the United States which is, compared to other first world countries, very dysfunctional and increasingly difficult to navigate to get one’s health care needs met. It is hoped that by better understanding the system one can better manipulate it to get one’s health care needs met and to help change it to a system that better meets the needs of the American people.

People learn poor interpersonal skills from their parents in their first 6 years.

From The Conversation 06/09/26, "Kids learn to bully from adults’ threats, manipulation and criticism – a child psychologist explains how parents can model better tactics"

Think about all the ways you can get someone to do something that’s undesirable to them, especially if you have power over them. You can use positive tactics, such as direct encouragement, incentives and praise. You can try negative tactics, such as threats, manipulation and force. Some – asking politely, saying please and thank you each time – work better than others, such as nagging or pleading.

Children learn which tactics work and are acceptable by seeing how adults, who hold power over them, employ them.

On one extreme, observing aggression between parents increases risk for children’s heightened aggression and violence in their own social relationships. Stanford psychologist Albert Bandura’s seminal 1961 “Bobo Doll Study” found that preschool children who saw an adult hit and kick a life-size inflatable figure were more likely to be aggressive toward that figure when frustrated.

In my own research, I focused on children who were exposed to domestic violence between parents as early as in infancy. As adults, these now-grown children were more likely to be both victims and perpetrators of violence with their romantic partners. People were particularly likely to be violent as adults if they were exposed to domestic violence when they were in preschool, as opposed to later in childhood, suggesting early childhood is a particularly important time for parents to model healthy conflict resolution.

Parents and other authority figures teach young children better by what they do, how they behave, than by what they say or as the aphorism is stated, "Actions speck louder than words." 

At age 80 I reflect on how my ex-wife and I modeled conflict resolution for our 9 children and I realize now that it was pretty dysfunctional and had a negative influence on our children. There is not much to be done about it now but admit our mistakes and ask for forgiveness.

The key skill children learn is how to use power in their interpersonal relations. Sometimes this is described as "control issues." There are things that children want to do that they are told they can't, and things that children don't want to do that they are told they have to. These conflicts lead to power struggles. The interesting thing to observe is who is going to win and how do they do it, and what are the consequences of getting one's way?

Are there better ways of resolving these conflicts than others? Yes. What are they?

Community programs mitigate opioid deaths significantly.

David Wazana has written a great article for the Rochester Beacon entitled, "Rochester joins effort to raise naloxone awareness." which was published on June 12, 2026. 

Rochester’s Neighborhood Ambassador Program, a city-funded, community-driven program, seeks to address the opioid epidemic by recruiting and training neighborhood ambassadors in opioid crisis interventions. NAP also distributes naloxone kits, which contain naloxone nasal sprays and strips to test for fentanyl and xylazine.

According to preliminary data from the Centers for Disease Control, 2025 saw an almost 14% decrease in overdose deaths; New York, along with Rhode Island, North Carolina, Alabama, and Vermont, saw the largest decline, with 25% fewer overdose deaths in 2025 than in 2024.

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In Monroe County, opioid-related overdose deaths dropped from 433 in 2023 to 216 in 2024, a decline of 50%, according to recent data from the county medical examiner. The decline mirrors a national trend, which researchers and advocates like Klee attribute to harm-reduction efforts and increased access to Nalaxone, as well as growing awareness of the dangers of opioid use.

In 2023, at the height of the nationwide opioid epidemic, opioid overdose deaths peaked at 79,000 before beginning a steep decline, which has continued since then.

I have known many people professionally and personally who have died from opioid overdoses. I also know of people who have been saved from dying by the quick administration of naloxone.

Deaths from naloxone overdoses are devastasting for families and communities. In attempting to counteract these loses it is important to know, support, and utilize harm reduction strategies. The data indicates that they work saving lives and improving the health of individuals, and the well being of families and communities.

As a side note, David Wazana's article is a great example of solution oriented journalism. Kudos to him for his good article and for the Rochester Beacon for publishing it.

The Platinum Rule

As a child, I greedily absorbed the many books I read as visions of alternate lives. Now, still capable on occasion of the same sort of greedy absorption, I am also aware of books as structures of language and of specific problems that they set out to address.

Spacks, Patricia Meyer. On Rereading (p. 46). Harvard. Kindle Edition. 

As a Psychiatric Social Worker I have been taught and learned that the skill of empathy is essential to good Social Work practice. In order to become skilful in empathy a person can practice the “platinum rule” which is to do unto others as they would have you do unto them. To practice the platinum rule one must know how others, especially those different from oneself, want to be treated. How does one learn this? The easiest way is through reading and rereading. As Spacks puts it, to experience “visions of alternative lives.” In reading books and working with people from different cultures, religions, generations, etc. I often feel like a voyeur. This is one of the reasons I enjoy my profession so much. I am endlessly curious about other people’s lives and experiences.

Intolerance of ambiguity can be a problem creating more problems

Some people tolerate ambiguity better than others who tend to see the world in black and white. The intolerance of ambiguity results in psychiatric symptoms of control, anxiety, depression, irritability, and compulsive behaviors such as drinking and drugging, pornography abuse, over working.

My mother used to call people who overthink things "worry warts."

How can people who have difficulity tolerating ambiguity and uncertainty be helped? The easy strategy for symptom relief is medication whether licitly subcribed by a health care professional or self administered having been obtained "off the street."

People who have difficulty with ambiguity have what is sometimes called an "insecure attachment style." Trust is a big challenge since negativity and pessimism are predominant thought processes. It helps if the person has relationships in which partners are reliable, honest, predictable and "there for them." The partner being non anxious, secure, and able to tolerate ambiguity is reassuring and soothing and the insecure person is able to "lower their guard" a bit and take a few bricks out the wall that they have surrounded themselves with to protect and defend themselves from the threat of future hurt.

People with difficulty tolerating ambiguity often are over controlling, rigid, stubborn, have a need to be right about everything, and insist that things be just so as they expect and demand. People they are in relationship with and trying to control often object to this style of interaction and the very things the controlling person was afraid of happening, happens. The attempt at controlling, and the other person objecting, rejecting and abandoning the person, is the very thing the person was trying to avoid by being so controlling in the first place and so there is a vicious cycle with the interaction escalating unitl a rupture occurs. In the extreme this interative pattern can lead to intimate partner violence, IPV.

Medications will not change the interpersonal activities engaged in this problematic situation. Often outside therapy individually and sometimes with couples and families can be helpful. The person with difficulty tolerating ambiguity needs help in managing their anxiety generated by uncertainty so they can manage their individual and interpersonal functioning in a more satisfying and fulfilling manner.

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Being alone with your own mind

As far as being left with one's own mind goes, the biggest barriers and obstacles to facing oneself is fear and guilt. In our psychiatric discourse, fear is described as "anxiety" and is medicated, and guilt is described as "trauma" and "PTSD" and is subject also to medications and EMDR and CBT.

Guilt, though, is a fundamental existential awareness that we have separated ourselves from our Transcendent Source and that Source will punish us for our egotistical belief that we can be the author of our own lives. This fear of punishment for our separation contributes to all kinds of psychiatric symptoms, the greatest of which is the feeling of being victimized for whatever reasons we can conjure up to blame others for our unhappiness.

In AA people are encouraged to face themselves in the fourth step which few people do unless they are interested in actually working the twelve step program.

Peace, which we all yearn for, is based on facing ourselves and joining once again with our Transcendent Source whatever we conceive that Transcendent Source to be. Psychotherapists are walking with people as we all go home. 

Tension is a characteristic of an emotional system

The systemic tension is in the system not in solely in one part although one component is sometimes known as the "symptom bearer." But the symptomatic member of the system can change rapidly as in "hot potato, hot potato, who's got the hot potato."

One person in the system is sometimes scapegoated because it serves the other parts of the system and maintains system homeostasis. Systems, to main homeostasis, often engage in human sacrifice.

Having been trained as a strategic family therapist, I was taught to ask, "What is the function of the symptom for the system?" When we look at the high levels of systemic tension in the United States today where fingers point to many scapegoats, as therapists looking at the system dynamics, we might ask where we can best intervene to jog the system onto a better level of functioning? When we make these interventions, they may cause, initially, an increase in stress because the system is destabilized and thrown into disequilibrium, which is a good thing if change is to occur, but as the therapist, we need to professionally and responsibly guide this restabilization to a more constructive, healthy way of functioning.

Nonviolent advocacy is the better way to go than further violence or even resistance alone. So the question we might ask ourselves is what do we love and how do we bring it about. Martin Luther King, Jr. was not against racism per se, but was an advocate for justice the arc of which bends slowly but inevitably to making heaven on earth when everybody loves everybody all the time.

How do we do this? One person at a time. I can love the sinner, but hate the sin. We can commit ourselves to stop wringing our hands and do something good today to somebody who crosses our path. This can be challenging in difficult times, but something that we psychotherapists are committed to.

Who should I love? - Watch Video