Background: The Cynefin Framework is a sense-making tool for problem-solving, and I often use it as a foundational reference when exploring how we approach the work we do.
Today, I asked an AI to create a new sense-making framework specifically for understanding and addressing illness—entirely independent of existing models. The aim was to move beyond a one-size-fits-all perspective and instead define distinct domains of illness, each requiring a different approach to diagnosis and management.
The response was thought-provoking and worth sharing—not as a definitive framework, but as an idea. It’s open to challenge, critique, and refinement. Just a starting point for thinking differently about how we categorise and respond to illness.
Here’s what it said:
Building a new sense-making framework for illness requires stepping away from the problem-solving context of business and into the lived experience of the human body, medical science, and clinical practice.
The core of this framework is built on two fundamental axes that define the experience of illness:
The Axis of Understanding: To what degree do we understand the cause and mechanism of the illness?
The Axis of Manifestation: How clear and consistent are the illness’s signs, symptoms, and progression?
By crossing these, we can define four distinct domains of illness, each requiring a fundamentally different process for sense-making and action.
Here is the Aetiology & Presentation Framework (APF) for Illness.
The Aetiology & Presentation Framework (APF)
The Two Axes:
X-Axis: Aetiological Clarity (Cause & Mechanism)
Y-Axis: Presentational Clarity (Signs & Symptoms)
The Four Domains:
Domain 1: Mechanical Failure (Known Cause, Consistent Presentation)
Description: This is the domain of “broken parts” with a clear, established pathophysiology. The link between cause and effect is direct and well-understood. A specific fault leads to a predictable set of symptoms. Think of a bacterial infection (pneumonia), a bone fracture, or a nutrient deficiency like scurvy.
Sense-Making Process: DIAGNOSE → TREAT → CURE
Domain 2: Systemic Dysregulation (Unknown (or Complex) Cause, Consistent Presentation)
Description: The body’s complex systems are out of balance. We see a consistent pattern of symptoms, but the root cause is multi-factorial, involving genetics, environment, and lifestyle. There is no single “bug” to fix. Examples are Type 2 Diabetes, Hypertension, and many autoimmune diseases like Rheumatoid Arthritis.
Sense-Making Process: CHARACTERISE → MANAGE → STABILISE
Domain 3: Idiopathic Cascade (Unknown Cause, Inconsistent Presentation)
Description: This is the most complex and frightening domain. It begins with an unknown trigger and sets off a cascade of symptoms that vary wildly from person to person. The presentation is idiosyncratic and often shifts over time. Examples include Chronic Fatigue Syndrome (ME/CFS), Fibromyalgia, and some complex post-viral syndromes (like Long COVID for many).
Sense-Making Process: PROBE → RELIEVE → ADAPT
Domain 4: Masked Pathology (Known Cause, Inconsistent Presentation)
Description: Here, we know the underlying cause (e.g., a specific genetic mutation, a known virus), but its presentation is highly variable and unpredictable among individuals. The “what” is known, but the “how it will show up” is not. Examples include Huntington’s Disease (known genetic cause, variable age of onset and symptom profile), HIV (known virus, highly variable progression and manifestations), and BRCA genes (known high risk, but not a guarantee of cancer).
Sense-Making Process: PREDICT → MONITOR → INTERVENE
Summary of the APF Framework:
Critical Context & Limitations:
Patient-Centricity: A patient’s illness can move between domains as science advances or as their condition evolves. Lyme disease moved from Domain 3 (Idiopathic Cascade) to Domain 1 (Mechanical Failure) once the bacterium was identified.
The “Central Pit”: The center of the framework, where both cause and presentation are utterly chaotic, represents a state of medical crisis and confusion. The primary process here is STABILISE → CONTAIN—to prevent harm and gather enough data to push the illness into one of the more understandable domains.
Not a Replacement for Cynefin: While structurally reminiscent, this framework is built from the ground up for the context of illness. It acknowledges that “best practice” (the Clear/Mechanical Failure domain) exists in medicine, but it also creates space for the emergent, probe-based strategies needed for the most complex chronic illnesses, which are often poorly served by a purely diagnostic-cure model.
This framework provides a mental model for patients and clinicians alike to understand what kind of problem they are facing and, most importantly, what kind of process is most appropriate for tackling it.