Big-O is a foundation for all of those things you mentioned as a true foundation. Don't know the former, you are likely to get tripped up by the later.

I get the feeling from your post that you get this though. Because at some point you have to transcend your knowledge of Big-O, pattern languages, and go through those stages of being an Architecture Astronaut, second-syndrome, failing, failing better, and then maybe even succeeding in what you do.

Then things begin to get interesting.