A River Runs Through Me: Allostasis
A story of how we maintain stability through change: from primordial organisms to the interplay of energy, emotion, body and brain.
I have an advantage when it comes to understanding that emotions are in fact intimately linked to energy allocation in the body. I have a condition called reactive hypoglycemia. That means that my blood sugar goes down very quickly into hypoglycemia. Even writing about this, I can almost sense the familiar symptoms - my palms getting sweaty, vision a little blurred, general sense of unease and loss of control.
Over time, I have learned a few tricks to avoid this from happening. One is very intuitive - in reactive hypoglycemia body reacts with producing too much insulin so if I eat something sweet, the sugar spike will result in an equivalent dip in my blood sugar levels. So I need to avoid sugar. Yeah, I don’t eat sweet things. But that’s not everything. I also need to be careful about my emotional ‘diet’.
Early on upon developing this condition, I have noticed that my threshold for the blood glucose to plummet becomes way lower if I am emotional. Upset, angry, triggered, excited or exhilarated - it did not matter. Any of those feelings would result in my glucose balance becoming very precarious. Emotions, since then, were for me always intimately linked to energy metabolism in my body. I knew that being emotional meant that there was an increased demand on my body’s energy supply.
So much so, that before learning how to better manage it through self-regulation and better diet, I used to avoid any emotion-prone situations even stopping short of any conversation that had the potential to become emotionally charged.
But did I know this explicitly? Did the ideas about energy come into my mind when thinking about emotions in general? Not really.
This, I think, reflects the general attitude towards emotions. Think about the amount of volumes of literature or hours of movies made that are ultimately depicting human emotions. I mean we are talkin huge quantities of material, right? The energy management is NOT what comes up in those volumes. The energy metabolism is NOT what comes to mind first when we think about emotions.
In this piece, I will try to argue for the perspective that it maybe should.
To do this I will draw on a number of sources from the current neuroscience discourse and research. The writing of this piece also leverages my own masochistic tendencies that led me to read the hefty volume called Principles of Neural Design, by Peter Sterling and Simon Laughlin. The book is GREAT, but contains far too many references to the role of ion channels and pumps in the efficient nervous system design than anybody’s cerebral ion pumps should need to contend with. Still, I learned a lot, including that even the micro-worm C. elegans, with its tiny brain of 300 neurons, uses both dopamine and serotonin to adapt in sophisticated ways to its environmental and social needs. And that the living in the here and now mantra is not even true for organisms as simple as the bacteria E. coli - from its inception, it seems, life has adapted to adjusting itself to expected conditions and needs taking the past experiences into account. But I digress.
What Principles of Neural Design essentially doing is looking into the evolution from an engineering perspective trying to decode the principles of design that have emerged allowing the brains to be very efficient while being energy conservative. In the process they also uncover the overarching principles of the brain and answer the question of what the brains are really for.
The conclusions they reach will be crucial for our story.
Can that knowledge makes us better in humanning (I just made this verb up)? Become happier?
More specifically, for therapists amongst us, can it help us in becoming better therapists? And finally, for lovers of big ideas amongst us - can it expand our horizons of how we think of ourselves?
This are the questions that I set out to explore in this essay about allostasis. Come with me.
What Creatures Have Brain? And Why?
Not all living things have brains, right?
Bacteria don’t have brain. In fact no unicellular organism has a brain. But another very large class of organisms, with sometimes great complexity and differentiated tissues, do not possess brains. Can you think of what they are?
It is the plants, of course. Plants don’t have brains.
So what is so different about plants? Well, plants don’t have to move. They create their own ‘food’, right? Through the process of photosynthesis. Everyone else - bar some special cases - has to move about and forage or hunt for their food. In other words, everyone else is on the move in order to survive.
And if you are moving, the conditions around you are changing all of the time - and you need to be able to adapt to that and that includes your behaviour and coordination of your movement. It is a tall order, and that is where the brain comes into the equation.
Ultimately, it seems, when boiled down to the very essence, the brain’s purpose is not to think, not to feel, not to be happy or fulfilled - it is to coordinate survival of the organism in ever changing conditions and to do this under many constraints of organic design.
Principles of Neural Design, the book I mentioned in the intro, follows the complexification of information use from the primordial organisms such as the bacteria or paramecium - another bigger unicellular organism - who already use signalling molecules and chemical processes in order to optimise the survival through movement, shows how all neural design from its first iterations in simpler and earlier life forms to the super complex such as mammals or humans, is laid out to optimise those same strategies taking into account the physical features of its body. Only these are much easier to see in simpler organism - the guiding features of design are buried under layers of complexity in more complex ones.
So how the body comes into play in all this?
The body is the territory.
Because of our conscious experience - what reaches our consciousness - compounded by the everyday dualism that we are so used to - we tend to think of the brain as something that is producing the thoughts and feelings and commanding the body parts what to do and how to move. The internal dynamics of the body processes, on the other hand, seems to be left to its own devices.
However, nothing can be further from the truth.
There is the autonomic nervous system (ANS) and it effectively acts as an interface between the brain and the body.
But is the regulation of the dynamics of the various body systems such as the coordination of needs of different organs, the adjustment of the blood pressure, the immune system, the digestion etc coming from the body organs themselves, the internal milieu chemical rules or is it centralised and and coming from the brain? Furthermore, is the ANS controlled through the body directly or are the directives, ultimately coming from the brain? Remember, from the brain does not mean the conscious volitional brain.
For instance, take the digestion. The digestion starts from the moment the food enters the system. In fact, this is not true. The digestion starts before the food enters the system.
As the Pavlovian experiments demonstrated, the salivation, which is the first step in the process of digestion of the food happens prior to the food entering the body. It happens in anticipation and it is triggered and coordinated via the brain. The same is true for the digestive juices.
Now, it turns out that all of the things such as regulating blood pressure, way below the consciousness threshold, are also on all levels, ultimately regulated by the brain including the constriction of blood vessels, the blood volume and the heart rate adjustment. And it all works through anticipatory rather than through the reactive regulation.
For another in-depth tour of the push-and-pull dynamic of the different bodily systems in case of blood pressure I recommend this piece by Lauren Cortis.
The level of complexity here is representative of the levels of complexity of other systems that need to be balanced with precision moment to moment by the body brain duo, giving us just a peek into the vertiginous amounts of moving pieces in the balancing act that we call life.
OK. Then, maybe we can accept at the face value that the bulk of the autonomic control of the body is guided and goes through the brain and that the ultimate raison d’etre of those portions of the brain are to make the life of the body cozier and more prosperous by adapting to the internal and external changes, through anticipation. But surely, that cannot be the case for the thoughts and feelings? Those are not about hte body - they constitute the mind itself.
Guided by the same principle that accounts for evolution of all the traits and phenomena produced by the brain including the abstract thought and feelings - in fact, especially the energetically and computationally expensive ones such thinking or feeling - also should, ultimately serve the same purpose - maintaining the body in state of fitness and aliveness under perpetually changing internal and external conditions. Now that is a thought worth holding in mind.
The boundary becomes increasingly blurry when we start using this framework and also when we realise how much the brain ‘hardware’ responsible for management of body systems is intertwined with those responsible for emotions and decision making. A compelling, broader if still blurry, picture begins to emerge.
Body is boss here. The brain is the groundskeeper, the body is the territory.
To Save Energy And Space, The Brain Is Making Predictions All of the Time
Enter allostasis.
Allostasis is a concept that encapsulates all of the idea we have seen until now - and more - formalising it into the general principle of brain-body designs.
According to this view, the brain is the central place where all the demands of different body tissues, organs and systems are gathered assembled, and order or priorities is ‘decided’ allowing for redirection of resources in optimal way, minimising energy storage and expenditure.
This regulation, according to this view, best happens by anticipation rather through feedback loop reactions (although feedback loops are there).
In this way, through allostasis the body maintains stability through change - HENCE THE RIVER FROM THE TITLE. The river, too, somehow, and most of the time, maintains stability through constant change.
And the brain is THE organ for that anticipatory regulation.
Some key features of this choice of design are: (1) achieving an optimal balance between excessive storage and shortage of resources (2) setting priorities between different body systems through assigning and shifting priorities - this prevents resource bottlenecks - example that is provided is that during digestion, brain rerouted more blood to the gut and less to muscle while the opposite happens when there is physical effort involved, such as exercise. This allows for operating with a smaller overall blood volume, decreasing energetic and other resource needs, making the system optimized (3) errors in predictions are used to correct the model and reduce the future errors i.e. learning.
And the clever trick of the design is that anticipatory regulation does not only encompass the regulation of the internal milieu of the body. It also includes behaviour. So, if I am feeling thirsty or hot - signalling, by anticipation, to my conscious self that I might need to change something in order to address the hydration needs - I might decide to move into the shade, remove one layer of clothing or drink a water. This way, I might pre-empt the need to regulate these processes internally, which might prove less costly energetically speaking.
I know this might seem obvious. But this is only because we are used to it. It seems much less obvious and more like an ingenious solution when we think in term of reverse-engineering of life, and that is in part what the whole story of neural design and allostasis, tries to explain.
A big part of our environment are other humans. And other humans account for a big part of the change - beneficial or detrimental - in out environment. Big portions of our brain are dedicated to social cognition and it naturally ensues from this that the concept of allostasis extends to others around us. This is not lost on me and I will address this fascinating topic in another piece.
What Psychotherapy Has to Do With Energy Metabolism?
Now, I think this is one idea or a perspective that is mostly completely overlooked in therapy: the importance of efficient energy regulation. This is not to say that it is therapists’ or anybody’s fault per se - it really is quite counter-intuitive - as discussed before our mental states really do not naturally lead us to thinking about the body and its efficient resource and energy management. The two are quite disconnected and from what I can observe the same phenomenon not only in adults but also in children, very early on, I cannot help but wonder whether this disconnect is the design feature itself. But that indeed is a topic for another conversation.
Now that this perspective has so clearly been revealed to us - how are we gonna incorporate it into the therapy practice and framework (I am speaking for myself here, you might already have), and how the things we already do can be seen through this lens - is going to be the seed and the recurring ingredient for an ongoing reflection in this and many other essays to come.
Homeostasis Vs. Allostasis: What Is the Fundamental Difference?
Homeostasis. You have probably heard of it. It describes the set of parameters that the organism needs to stick to in order to remain alive. We can only survive with certain body temperature etc. Homeostasis is a state of the organism.
When one of the bodily parameters deviated from a set point the homeostatic regulation occurs. The homeostatic regulation is reactive, meaning that it operates through error detection and feedback correction loops.
If there is one fundamental difference to understand between the idea of allostasis and homeostasis is that allostasis is a process unlike homeostasis which is a state and that the former operates through anticipatory regulation while the latter paradigm relies on reacting rather than on predicting.
This is of course important if we post that the brain operates through prediction - as the framework of predictive processing does - and it makes sense to adopt a general principle of maintenance of the body balance that reflects that principle. And that would be the allostasis principle.
I should also say that this is not just an ad hoc ruling made to comply with a favourite framework du jour. There is plenty of evidence to support it.
Emotions and Energy
Now back to my original observation - the emotions have a profound link to energy metabolism. As I described in the intro, my reactive hypoglycemia makes it all too obvious: when I am feeling emotions that are in some ways pushing me to act or to react, to do something - whether they are positive or negative - as this happens both in excitement, being pumped up and positive anticipation and in anger, when I am triggered by something and become reactive to perceived threat, both physical and psychological.
So how we might draw a thread to explain this?
According to the Theory of Constructed Emotions, the emotions are the meanings we give to combination of affect that arises through interoceptive awareness - and now knowing what we know about allostasis and predictive processing - we can also say predictive reconstruction. Feelings are, according to this view, the interpretations of our bodily states that take our culture, our past history - what we could call our priors - and our current context, into account. I write more extensively about this in: Where the Wild Things Are and The Devil You Know.
But, as we have seen, interoception has all to do with allostasis and anticipation of metabolic needs of the body, right? And so, if in a certain context, my personal, biological and cultural, a certain situation is likely to require an increased energy expenditure - would that not create feelings such as anger, being ‘wired’ and alert, being in a state of positive anticipation and excitement? While these feelings are fundamentally different in their feeling tone or valence - some are perceived as pleasant and some unpleasant - their energy signature, so to speak (I just made this up) - might be the same.
That explanation would completely account for my symptoms related to strong emotions and ensuing low blood sugar.
And, this is - as I reveal to you today - why I instinctively bought into the Theory of Constructed Emotions - as it provided this fundamental link that was missing for me: how the mental (feeling and emotions) can be so tightly link with a specific body reaction (increased glucose consumption).
Despite my reactive hypoglycemia ‘advantage’, you might also have your ways to come to this experiental conclusion?
And as I said before, energy metabolism and therapy, it is a neglected viewpoint, but now adding emotions to that - it gives us even more to think about.
Where Is This All Happening In the Brain?
What areas of brain do you know? Let’s do a little quiz.
The amygdala? Check.
The thalamus? Maybe check. Definitely check if you read my stuff.
The anterior cingulate cortex? Maybe a faint check.
The insula. Probably yes. I have written about it before.
All of those, and much more are involved in allostasis. Now, I have written about interoception before, the capacity to receive and sense the states of the body and it is pretty straightforward to imagine why the interoception and allostatic networks would be tangled, right?
It indeed so much so that this network is referred to as the allostatic-interoceptive network.
The brain circuitry involved, it is thought, overlaps with two large brain networks: the default mode network (DMN) and the salience network.
The DMN has structures such as the ventromedial prefrontal cortex (vmPFC), medial orbitofrontal cortex (mOFC), parts of the cingulate cortex while the salience network has some of its key nodes in the amygdala, the insula and the thalamus.
Note here that amygdala is not seen anymore as the ‘fear centre’ or the ‘smoke alarm’ but more of a salience hub - part of what helps us determine what in our environment has value for us.
Now think about the areas of the brain you know are involved in emotional processing. If you need a reminder, I have written about it here. There a huge overlap. And so, if you need a little faith to start considering how energy allocation and emotions are linked, maybe start with that.
Maintaining Stability Through Change: Implications for Therapy
So what might be clinical implications?
Two things here: I will define allostatic load - a concept useful in this context and then I will suggest some immediate implications for the work of therapy. However, integrating the allostasis and related ideas explored can have far reaching consequences and I am yet to explore them in my work and in my writing.
Allostatic Load
One of the design features of allostasis is adaptability, rerouting of resources and shifting priorities. In other words the system is flexible and adaptive - it can stretch. But everything has limit and too much of stretching for too long takes its toll.