Allostasis and the Evolution of Human Design (Mit Press)

The eminent neuroscientist Peter Sterling has proposed a broader concept of health in his book, one that goes beyond the traditional "no-fault" concept of homeostasis. Sterling explains that health is optimal responsiveness, and it is often best treated at the system level, rather than focusing solely on local mechanisms.

Sterling's concept of allostasis, which he coined in the 1980s with Joseph Eyer, suggests that the brain anticipates needs and efficiently mobilizes supplies to prevent errors, rather than simply correcting errors as in the homeostatic model. This evolutionary adaptation, Sterling argues, was designed to optimize energy efficiency, relying heavily on brain circuits that deliver a brief reward for each positive surprise.

However, modern life has reduced the opportunities for these positive surprises, leading people to seek them in unhealthy ways, such as through consumption of bigger burgers, more opioids, and activities that involve higher carbon emissions. The consequences of this behavior include addiction, obesity, type 2 diabetes, and climate change.

Sterling concludes that solutions to these problems must go beyond the merely technical and must instead focus on restoring the possibilities for daily small rewards and reviving the capacities for egalitarianism that were hard-wired into our nature.

The traditional medical education system has long been centered on the concept of homeostasis, where local mechanisms are responsible for maintaining a constant internal environment. However, Sterling argues that most parameters are not actually constant, and that the brain is definitely in charge, contrary to the traditional view.

Sterling's concept of allostasis offers a principled definition of health and disease that is not found in any medical textbook. Health, according to Sterling, is the capacity for adaptive variation, while disease is the shrinkage of that capacity. This perspective suggests that many significant conditions are best treated at the system level, rather than focusing solely on local mechanisms.

Overall, Sterling's work presents a compelling argument for a broader understanding of health and disease, one that takes into account the role of the brain and the larger systems at play. By restoring opportunities for positive surprises and egalitarian values, Sterling believes we can address the pressing health and environmental challenges of our time.

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