The Big Picture: Systems Thinking vs. Symptom Whack‑a‑Mole
Understanding Symptoms When Everything Is Connected
In Brief
Alice has become a walking collection of individual problems—ten different symptoms, ten different specialists, ten different treatments—yet she experiences one life that has become unrecognizable.
Whack-a-mole medicine treats symptoms as independent moles popping up randomly, but Alice’s experience reveals every symptom is connected to every other symptom through hidden biological networks.
Her body is like a drought-stricken forest where cancer treatment created the dry conditions—treating scattered fires misses that new symptoms keep emerging from the same underlying vulnerability.
Systems thinking asks a different question: instead of “How do we treat each symptom?” it asks “What pattern is generating these symptoms?” and focuses on forest restoration rather than firefighting.
The paradox: systems work often requires doing less, not more—removing obstacles to the body’s natural healing capacity rather than adding treatments for each symptom.
The moles keep popping up because the ground is unstable—when we stabilize the ground, symptoms stop appearing because the conditions that created them have changed.
Alice reviews the stack of appointment reminders on her kitchen counter—rheumatology follow-up in three months, endocrinology check-in next week, sleep medicine consultation scheduled for January. Each appointment represents another specialist, another piece of her complex medical puzzle, another attempt to address the symptoms that have reshaped her life since cancer treatment.
The rheumatology appointment had been typical: joint pain and morning stiffness discussed efficiently, inflammatory markers reviewed, a low-dose anti-inflammatory prescribed, and a follow-up scheduled for three months out—the earliest available slot. Walking to her car afterward, Alice had felt the same familiar tightness in her stomach that followed most of her medical appointments these days. It’s the same feeling she’d had after the sleep specialist prescribed medication for her insomnia. The same feeling after the psychiatrist offered antidepressants for her brain fog. The same feeling after the dermatologist gave her a cream for her skin lesions.
Each specialist is competent, caring, and focused on their particular domain. Each has a reasonable treatment for her specific complaint. But as Alice walks to her car with yet another prescription, she can’t shake the feeling that something fundamental is being missed.
She has become a walking collection of individual problems: fatigue (endocrinology), joint pain (rheumatology), brain fog (neurology), sleep problems (sleep medicine), mood issues (psychiatry), skin lesions (dermatology), digestive trouble (gastroenterology), neuropathy (pain management), cancer surveillance (oncology), and heart monitoring (cardiology). Ten different symptoms, ten different specialists, ten different treatments.
But Alice doesn’t experience ten different problems. She experiences one life that has become unrecognizable.
Through our exploration of balance, normal labs, and the walls that divide medicine, we’ve established that Alice’s fatigue, joint pain, brain fog, and sleep problems are expressions of a single, deeper pattern of systemic disruption. Now we need to understand exactly how this interconnectedness works—how her symptoms actively reinforce each other through hidden biological networks—and why treating them individually keeps failing.
This is where the difference between whack-a-mole medicine and systems thinking becomes crucial. Alice’s experience doesn’t just demonstrate that her symptoms are connected; it reveals the specific mechanisms by which they strengthen and perpetuate each other, making isolated treatments not just ineffective but sometimes counterproductive.
The Whack-a-Mole Problem
Picture the classic arcade game: mechanical moles pop up randomly from different holes, and your job is to whack them back down with a hammer. The faster you whack, the higher your score. But no matter how quick you are, the moles keep popping up. The game never really ends—it just gets faster and more chaotic.
Modern medicine often approaches complex health problems the same way. A symptom appears, you treat it. Another symptom pops up, you treat that one too. The sleep problem gets a sleep medication. The joint pain gets an anti-inflammatory. The brain fog gets attributed to depression and treated with an antidepressant. The fatigue gets blamed on thyroid dysfunction and addressed with hormone replacement.
Each intervention is logical, evidence-based, and often helpful in isolation. But the underlying assumption is that each symptom is independent—that fatigue and joint pain and brain fog are separate moles popping up from different holes, requiring different hammers.
Alice’s experience suggests otherwise.
Alice’s Interlocking Day
Consider a recent Tuesday in Alice’s life, examined not through the lens of individual symptoms but as a single, interconnected system:
5:30 AM: Alice wakes before her alarm, mind already racing with worry about the day ahead. Her sleep has been fragmented for hours—not the deep, restorative sleep that allows the brain to clear metabolic waste and consolidate memories, but the light, anxious skimming across consciousness that leaves her more tired than when she went to bed.
6:00 AM: She tries to get out of bed, but her joints are stiff and painful, particularly in her hands and knees. The stiffness is worse on days when her sleep is poor, though she’s never mentioned this connection to either her rheumatologist or her sleep doctor.
7:30 AM: At breakfast, Alice feels nauseated and has no appetite, even though she knows she should eat something. Her digestive system, which relies on regular circadian rhythms to produce appropriate enzymes and hormones, has been thrown off by her disrupted sleep. She forces down some toast, but it leaves her feeling heavy and foggy rather than energized.
9:00 AM: At work, Alice struggles to concentrate during her first meeting. Her brain fog is thickest in the morning, when her cortisol should be naturally high and her mind should be sharp. But her stress response system, exhausted from months of poor sleep and chronic inflammation, can’t mount the appropriate hormonal response to help her feel alert and focused.
11:00 AM: Alice’s hands are ice-cold despite the warm office, and she finds herself making small errors in tasks that used to be automatic. Her nervous system, overwhelmed by chronic inflammation and sleep deprivation, is prioritizing core functions over peripheral circulation and fine motor control.
1:00 PM: After lunch, Alice experiences a crash that makes her want to put her head on her desk. Her blood sugar regulation, compromised by poor sleep and chronic stress, can’t handle the glucose load smoothly. The inflammatory cytokines circulating in her system further interfere with insulin sensitivity.
3:00 PM: The joint pain that started in the morning has intensified, and Alice finds herself moving stiffly. The inflammatory processes that cause her morning stiffness are exacerbated by the stress hormones her body has been producing to try to maintain function despite exhaustion.
6:00 PM: At home, Alice feels too tired to cook dinner or engage with her family. The fatigue isn’t just physical—it’s cognitive and emotional. Her depleted stress response system can’t provide the energy needed for normal daily activities.
9:00 PM: Despite being exhausted, Alice feels wired and anxious. Her cortisol rhythm, which should be dropping to prepare her for sleep, remains elevated due to the inflammatory stress her body has been under all day.
11:00 PM: Alice lies in bed with her mind racing, knowing that poor sleep will make tomorrow worse but unable to quiet the cycle of inflammation, stress hormones, and sympathetic nervous system activation that keeps her awake.
Every symptom Alice experiences is connected to every other symptom. Her poor sleep worsens her inflammation, which disrupts her hormonal balance, which impairs her brain function, which increases her stress response, which interferes with her sleep. It’s not ten separate problems—it’s one interconnected web of dysfunction.
The Forest Fire Metaphor
Remember our tale of two forests from earlier in this series—how one team of experts focused on fixing individual trees while missing the ecological conditions that determined the whole forest’s health? Alice’s situation reveals a similar pattern, but now we’re dealing not just with failing trees, but with fires spreading through a compromised ecosystem.
Imagine a drought-stricken forest. The trees are stressed, the underbrush is dry, and the soil has lost its ability to retain moisture. When lightning strikes, it doesn’t just create one fire—it creates conditions where fires can start anywhere and spread quickly.
You could station firefighters at different locations to put out each flame as it appears. And this approach would work for a while. But as long as the underlying conditions remain—the drought, the dry brush, the depleted soil—new fires will keep starting faster than you can extinguish them.
Alice’s body is the drought-stricken forest. The cancer treatment created the initial conditions: depleted cellular energy systems, disrupted gut microbiome, damaged nervous system regulation, compromised detoxification pathways, and chronically activated immune responses. These are the “dry conditions” that make her vulnerable to multiple symptoms.
Her individual symptoms—fatigue, joint pain, brain fog, sleep problems—are like the scattered fires. Treating each one separately is like deploying firefighters to individual hot spots. The treatments may provide temporary relief, but they don’t address the underlying conditions that allow new symptoms to keep emerging.
The Hidden Networks
What makes Alice’s situation even more complex is that her symptoms don’t just coexist—they actively reinforce each other through hidden biological networks that her different specialists may not be able to fully consider
The Inflammation-Sleep-Mood Network: Alice’s poor sleep increases inflammatory cytokines, which interfere with neurotransmitter production and contribute to both depression and cognitive dysfunction. The depression and anxiety then make it harder to sleep, creating a vicious cycle that no single intervention can fully address.
The Stress-Digestion-Immune Network: Alice’s chronic stress response disrupts her digestive function, which compromises nutrient absorption and gut barrier integrity. This leads to increased immune activation and systemic inflammation, which further activates her stress response system.
The Hormonal-Energy-Sleep Network: Alice’s disrupted sleep interferes with growth hormone production and cellular repair processes, leaving her feeling fatigued. The fatigue makes her rely more heavily on stress hormones to maintain function, which interferes with sleep quality and perpetuates the cycle.
The Circulation-Pain-Anxiety Network: Alice’s chronic inflammation and autonomic nervous system dysfunction affect circulation, contributing to her cold hands and feet. The pain and discomfort increase her anxiety, which further disrupts autonomic balance and circulation.
These networks don’t exist in isolation. They overlap and interact in ways that create emergent properties—system-level patterns that can’t be reliably predicted by looking at individual components alone.
Why Whack-a-Mole Fails
Alice’s experience illustrates three fundamental problems with the whack-a-mole approach. While these problems are distinct, they often work together to create vicious cycles that make healing more difficult:
Problem 1: Symptom Interdependence
Alice’s symptoms don’t exist in isolation—they actively reinforce each other through biological networks. Her poor sleep worsens inflammation, which clouds her thinking and disrupts her mood, which makes it harder to sleep. Her joint pain increases her stress, which elevates cortisol, which interferes with her immune system’s ability to calm inflammation. When you treat just the sleep problem or just the joint pain, you miss that these symptoms are actually expressions of the same underlying network dysfunction. This is why Alice’s sleep medication initially helped her fall asleep but couldn’t address the inflammatory-stress cycle that was driving her sleep disruption in the first place.
Problem 2: Compensatory Responses
When you suppress one symptom without addressing its root cause, Alice’s body compensates by shifting the dysfunction elsewhere—often creating new problems that seem unrelated. Her anti-inflammatory medication reduced her joint pain, but by inhibiting prostaglandin-mediated mucosal protection, it increased her risk of acid-related stomach injury (gastritis, ulcers). Additionally, because the anti-inflammatory meds are processed by the liver, prolonged use leads to stress on the liver. These compensatory responses eventually manifested as digestive issues and elevated liver function tests, which were then treated as separate problems. The compensation created a cascade: treating joint pain → compromised gastric protection → liver metabolic burden → new symptoms → new medications → new side effects.
Problem 3: Treatment Fragmentation
When different specialists address Alice’s symptoms without coordinating with each other, the treatments themselves can interact in ways that worsen her overall condition. Her sleep medication affected her blood pressure, which influenced her cardiologist’s treatment decisions. Her antidepressant interacted with her thyroid medication, changing how her body processed hormones. Each specialist optimized for their domain while remaining unaware of how their interventions affected the others. This fragmentation created a treatment burden where Alice was managing not just her original symptoms, but also the complex interactions between multiple medications prescribed by different doctors.
The Vicious Cycle
These three problems don’t just coexist—they amplify each other. Symptom interdependence means that partial treatments trigger compensatory responses. Compensatory responses create new symptoms that get treated by different specialists, leading to treatment fragmentation. Treatment fragmentation creates drug interactions and side effects that further disrupt the interconnected symptom networks. Alice found herself caught in an accelerating cycle where each intervention, while logical in isolation, contributed to a more complex and unstable overall pattern.
The Systems Alternative
Systems thinking offers a different approach: instead of asking “How do we treat each symptom?” it asks “What pattern is generating these symptoms?”
From a systems perspective, Alice doesn’t have separate problems with sleep, inflammation, mood, cognition, and energy. She has one integrated system—her body—that has lost its ability to maintain healthy balance across multiple domains.
The systems approach would focus on restoring the underlying conditions that support healthy function:
Restoring Circadian Rhythm: Instead of just medicating sleep, address the light exposure, meal timing, activity patterns, and stress management that allow natural sleep-wake cycles to emerge.
Supporting Stress Recovery: Instead of just treating anxiety, address the chronic activation of stress response systems through nervous system regulation, breathing practices, and creating genuine safety cues for the body.
Reducing Inflammatory Load: Instead of just suppressing inflammation, address the sources of inflammatory stress: gut dysfunction, chronic infections, environmental toxins, and emotional stress.
Improving Cellular Energy: Instead of just managing fatigue, support the mitochondrial function, nutrient status, and metabolic flexibility that allow cells to produce energy efficiently.
These interventions don’t target individual symptoms—they target the systemic dysfunctions that give rise to multiple symptoms simultaneously. In future posts, we’ll talk much more about how to do this.
The Forest Restoration Approach
Returning to our forest fire metaphor, the systems approach is like forest restoration rather than firefighting.
Instead of just putting out fires as they appear, forest restoration addresses the underlying conditions: restoring soil health, replanting diverse vegetation, reintroducing natural water cycles, and creating conditions where the ecosystem can maintain its own balance.
This approach takes longer than firefighting, and the benefits aren’t always immediately obvious. But over time, a restored forest becomes naturally resistant to fires. The improved soil retains moisture, the diverse plant life creates natural firebreaks, and the healthy ecosystem can respond adaptively to environmental stresses.
Alice’s healing journey requires a similar approach. Instead of just treating symptoms as they appear, she needs support for the underlying systems that, when healthy, naturally maintain balance across multiple domains.
Alice’s Systems Profile
When we look at Alice through a systems lens, a clearer picture emerges:
Primary System Dysfunction: Chronic activation of stress response systems due to the trauma of cancer treatment, leading to disrupted sleep, inflammation, and metabolic dysfunction.
Secondary Effects: Poor sleep quality leading to impaired cognitive function and mood regulation. Chronic inflammation affecting joint health, digestion, and circulation. Disrupted metabolism contributing to fatigue and temperature dysregulation.
Compensatory Patterns: Body prioritizing survival functions over optimal function, leading to energy conservation, heightened vigilance, and reduced capacity for repair and regeneration.
Reinforcing Cycles: Each dysfunction reinforcing others through biological feedback loops, creating stable but unhealthy patterns that resist isolated interventions.
This systems profile suggests that Alice doesn’t just need ten different treatments for ten different problems. She needs a coordinated approach that addresses the central dysregulation while supporting her body’s natural capacity for balance and repair.
The Paradox of Systems Work
Here’s what makes systems thinking both powerful and challenging: it often requires doing less, not more.
Alice’s instinct—reinforced by her medical team—has been to find a solution for each symptom. More medications, more specialists, more interventions. But systems thinking suggests that her body might be overwhelmed by trying to adapt to too many inputs at once.
What if instead of adding more treatments, Alice focused on removing obstacles to her body’s natural healing capacity? What if instead of fighting each symptom individually, she created conditions that allow her entire system to shift toward health?
This doesn’t mean ignoring symptoms or avoiding medical care. Alice’s clear scans remain critically important, and her symptoms require ongoing medical management. But it does mean holding a larger view—seeing her symptoms as messages from an intelligent system seeking balance rather than random malfunctions to be suppressed.
What Comes Next
Systems thinking offers a different approach than treating symptoms individually, but different traditions offer different maps for understanding complex biological systems. In our next exploration, we’ll examine how these various approaches—despite using different languages—converge on similar insights about systemic healing.