What is Health? allostasis and the evolution of human design (some conclusions)

Peter Sterling (University of Pennsylvania)

Abstract:  Many claim that the conditions of human life began improving with the Enlightenment (1700-1800 CE), and now we are better off by every measure––food, health, lifespan, and so on.  But recently U.S. death rates have been rising from suicide, alcohol, and drugs. These “deaths of despair” are exceeded tenfold by rising deaths from type 2 diabetes, hypertension, and cardiovascular disease––caused by overwhelmingly rich “foods of despair.” Also rising in parallel are deaths from mass shootings, which should be viewed as “murders of despair.” Meanwhile, atmospheric CO2 rises steeply, threatening the health of our planet. All have a single cause: compulsive consumption­: eat, drink, snort, and shop––till-we-drop. What gives?

           Our ancestors, migrating from Africa across deserts, mountains, and oceans, faced continual challenge. They were rewarded for each morsel of food, encountered episodically, by a satisfying pulse of dopamine. Risks of scarcity were reduced by sharing­––which rewarded both givers and receivers. Today we obtain food and comfort with neither effort, nor surprise, nor need to share. “Jobs”, learned in minutes or days, offer neither challenge nor surprise, and so are unrewarding. Lacking intermittent pulses of dopamine, we grow uncomfortable and seek relief from substances that act powerfully to release dopamine in great, addicting surges.

           Standard medicine promotes drugs to treat addiction by blocking the reward circuit. But strategies to prevent satisfaction cannot work.  Standard economics promotes “growth” for more “jobs”. But growth is incompatible with reducing CO2, and “jobs” are what now drive us to despair. To restore bodily and planetary health, we need healthy minds. We must re-expand opportunities for small satisfactions via challenging activities that require life-long learning and thereby rescue the reward system from its pathological regime.

      https://twitter.com/whatishealth21

      https://mitpress.mit.edu/books/what-health

     https://www.med.upenn.edu/apps/faculty/index.php/g275/p7333