Niklas Luhmann’s book Introduction to Systems Theory (2012) offers a theoretical framework for understanding the functioning of ‘modern society’. It is a grand theory in the sense that it aims to provide a universally applicable theory to every aspect of contemporary society. The book contains a series of essays through which Luhmann introduces and constructs his theory of distinctions. Based on two key philosophical standpoints: Husserl’s assertion that the world as a whole cannot be known, rather the world can only be known partially, and Wittgenstein’s warning that observations of facts are themselves facts that can be observed, the book is framed as a response to contemporary social conditions and the difficulties these pose for sociologists.
What was difficult about reading Luhmann was its theoretical abstraction and absence of empirical examples, which required us to use our own research experiences in order to get to grips with the arguments being made. As a group of interdisciplinary researchers in a public health department, discussions started off by thinking about Luhmann’s concept of the ‘system’ in relation to ‘health systems’. This was a bit of a problematic starting point and, as is so often with social theory, required us to try and let go of everyday concepts (at least within public health) like ‘systems’, ‘communication’ and ‘environment’. However, this tension was also a way to reflect on what Luhmann may offer in terms of studying ‘systems’ as sociologists.
For Luhmann, a system is made when two or more people communicate and coordinate actions meaningfully. In the process of communication a distinction is made – a cut – and through this action a ‘system’ is defined against its ‘environment’. Each system has a different environment, and what is part of one system forms the environment for another. As such, an environment is unique to any given system. Luhmann is interested in how systems distinguish themselves from their environment and from each other, rather than how these systems enable society to function. This is a very different approach to the normative idea of a health system, as a set of stable of principles which can be applied to different geographical contexts. Although contingency is recognised, the basic form and meaning of a health system is relatively stable. For example, the WHO describes a health system as a configuration of services, and although the exact configuration is context dependent what makes up a system is understood as constant. Luhmann destabilises any sense of a system as constant and stable because a system is always a result of a contingent distinction which has to be continually made for the system to exist.
Of course, for many social scientists the normative concept of a health system is rather problematic. Instead, socially, politically and culturally situated understandings and materialisations of health and health services are often the focus of sociological accounts of health systems. Yet Luhmann offers a rather different way of approaching systems, where the empirical focus is located in the work of the system distinguishing itself from its environment, rather than the playing out of the system ‘on the ground’. Observing distinctions allows for the empirical study of the actions which mobilise and maintain the very idea of a health system as a valued infrastructural achievement. Indeed, one of Luhmann’s key points is that a cut can always be observed – what he calls a second order distinction. In a first order observation, observers simply observe what they observe, for example a table. In the act and communication of observation no observer can observe how he observes, for example between a table and a chair, at the same time as he observes what he observes. A second order distinction enables this observation of observations and therefore the other side of the distinction becomes apparent. For Luhmann it is this unity of first order and second order distinctions which allows sociologists to get closest to ’reality’.
The interest for Luhmann is who is the observer? And what are the conditions of observations? If every observer holds an equal stake in ‘truth’, then the only possible deconstruction is to observe the observing systems and distinguish the observers. This de-constructive approach forms the rationale for Luhmann’s second order observation. If we return to the idea of ‘health systems’, then, rather than trying to study how health systems are re-appropriated on the ground, or taking for granted the very things or services which make up a health system in particular instances, we could follow Luhmann’s ‘theory of distinctions’ and pay attention to the other side of the distinction, foregrounding what becomes unobservable as a result of the observations made by a health system.