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Understanding Allostasis: Can Society Change Its Setpoints?

From opioids to climate change, social repair as antidote for over-consumption.

This post is part 3 of a series.

Part 1 of Understanding Allostasis introduced the Paradigm of Allostatic Orchestration (PAO) as it applies to our health and the range of our psychophysiological abilities to predict, learn and adapt to ever-shifting internal and external environments. Part 2 described ways in which we can broaden our set-points (ranges of adaptation) leading to increased resilience and better health.

This article, Part 3, asks questions about what setpoints society may have, and when unhealthy, what might we do to improve them. The answers provided are based on 3 recent conversations I had with 3 experts about allostasis and resilience: The first was with neurobiologist Peter Sterling, who coined the term allostasis along with Joseph Eyer in the 1980s, the second with neuroscientist Sung Lee who has advanced the concepts of allostasis in the PAO, and a third interview with Kevin Gallagher, author, attorney and founder of Emergent Resilience – a nonprofit that helps organizations build resilience in tumultuous times.

Vitaliy Paykov/Unsplash
Source: Vitaliy Paykov/Unsplash

Peter Sterling has studied how human physiology changes to adapt in anticipation of changing environments, especially the past 250 years since the Industrial Revolution. He notes that for the US population’s blood pressure begins to increase upon entry into elementary school (for many the beginning of social pressures and expectations) and continues to increase throughout the lifespan. Yet, this is not so for populations in some other countries. Why? (He thoroughly answers this and similar questions in his new book, What is Health? Allostasis and the Evolution of Human Design1that will be released next week).

Sharon McCutcheon/Unsplash
Source: Sharon McCutcheon/Unsplash

In addition to blood pressure, obesity, ADHD prescriptions, opioid addiction, mass shootings, and carbon emissions continue to increase along with “deaths of despair”2 that include suicide, but also many types of over-consumption related deaths. He sees these as the result of not enough intrinsic and moderate hits of dopamine distributed throughout the day and too many overly available, super-sized hits of dopamine from the foods, drugs and other substances -- and I’ll add high emotion-low-content television. Combined with chronic hyperarousal of daily stress without adequate social support, it seems to be killing us. The US life expectancy is going down and disproportionately so for marginalized people and minorities.

Are we outsourcing our joy?

Our nervous systems learn and adapt to bigger and bigger hits of dopamine from external sources and this may be sought out in response to the inherent distress of social inequality and feeling "other." Sterling noticed in the 1960s how black communities had a disproportionate amount of strokes from chronic high blood pressure, the primary cause being social disruption leading to chronic hyperarousal of the nervous system, chronic inflammation, limited choices and opportunities, and poor health. This might lead us to see that social repair and closing income gaps are fundamental antidotes to the deaths of despair arising from social injustices and may also be true for anyone experiencing social separateness.

Sterling sees that health in the US could improve if healthcare becomes based on:

1. Social inclusion

2. Practicing our personalized gifts across a lifespan, meaning exercising unique talents and finding meaningful work, as well as prioritizing people over productivity, and

3. Expanding personal experiences and sacred practices rather than having vicarious experiences on our electronic devices.

He adds that working conditions such as more paid time off for all employees, catching up with Europe regarding maternity and paternity leave, and improving childcare would help improve quality of life for everyone in the US.

Sterling says to change, we need to change the prediction. “The goal is to reduce demand for long enough for the system to “believe” the new prediction and readapt.” This means we can reduce the demand for hyperarousal, elevated blood pressure, and dopamine hits from unhealthy substances so the system can reset. It seems we must help each other to do so by changing policies, but also by building community.

Sung Lee and Peter Sterling agree that blame gets us nowhere and that repairing social fabric is key. According to Sung Lee it is “ultimately necessary for the brain to revise its prediction and re-orchestrate its downstream regulation.” Sung Lee adds that urban planning and architecture can express allostasis through thoughtful design of educational structures, commercial and civic facilities, public housing, correctional institutions, and public spaces that serve the people who use them, not the people who build them. He points also to mental and physical agility training and movement therapies such as yoga. He integrates neuroethics3 into the applications of the PAO stating: “The PAO is consonant with greater self-creativity, non-obsolescence, empowerment, and citizenship, which are intended as upgrades for the traditional concepts of autonomy, non-maleficence, beneficence, and justice, respectively.”

Shane Rounce/Unsplash
Source: Shane Rounce/Unsplash

These values align with the recommendations of the American Psychological Association (APA) that says in Mental Health and our Changing Climate (2017)4 “...the following are tips to consider that address personal attributes and support social cohesion:

  1. Build belief in one’s own resilience.
  2. Foster optimism.
  3. Cultivate active coping and self-regulation.
  4. Find a source of personal meaning.
  5. Boost personal preparedness.
  6. Support social networks.
  7. Encourage connection to parents, family, and other role models.
  8. Uphold connection to place.
  9. Maintain connections to one’s culture."

The goals, the APA says, include promoting the following:

  1. A sense of safety
  2. Calmness
  3. A positive sense of self and a sense of community efficacy
  4. Connectedness and
  5. Hope.

Continued Part 3B: Emergent Resilience: Allostasis for Health, Community, and our Climate.


1. Sterling, P. (February 2020) What is Health? Allostasis and the Evolution of Human Design. Cambridge, Massachusetts: The MIT Press.

2. Case, A. & Deaton, A. (Spring 2017), Mortality and Morbidity in the 21st Century, Bookings Papers on Economic Activity.

3. Shook, John & Giordano, James. (2016). Neuroethics beyond Normal. Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees. 25. 121-140. 10.1017/S0963180115000377.

4. Speiser, M. (2017). Mental Health and Our Changing Climate: Impacts, Implications, and Guidance. Washington D.C.: American Psychological Association.