(Note: This article is from the archive and was written c. 2022.)
Homeostasis (“similar/same” + “standing still/state”) as a concept has been around for a very long time. In medicine, the concept is that there is a certain set point of health that is optimal or necessary. Furthermore, if there is deviation from this state, processes are in place to shift the deviation back towards the optimal state and thus avoid disease.
The easiest place to see this is with fundamental physiological processes. For example, our body in general needs to have an acid-base balance, known as pH, of around 7.35–7.45. Our blood has an amazing pH balancing system built in using bicarbonate, HCO3–. If the pH starts getting out of range, our kidneys and lungs will start working overtime to bring it back within range.
Allostasis (“other” + “standing still/state”) was defined in the late 80s, but has a varying definition, sometimes seeming to supplant homeostasis, sometimes seeming to compliment it. In psychological and psychiatric literature, I tend to read it in a complimentary fashion, and that’s how I’ll address it here. Essentially, allostasis is when that balancing set point moves. Something is happening in your body that requires a change in physiological dynamic to meet new demands. So your body is still trying to stay in balance, but it can come at a price.
Let’s first consider going for a jog. When you first start moving, you can breathe easily. But as you continue, your breathing becomes harder and harder. If you keep going and push yourself, eventually your muscles will start to tire. All the tissues in your body require a certain amount of oxygen and nutrients to keep functioning. When you are sitting, lying, or walking, it’s usually easy for your body to maintain this homeostasis. When you begin jogging, your muscles start to require a lot more oxygen and nutrients. This creates a new set point, a new point needing to be met to keep the body in balance. This would be our allostatic point. The first thing your body does is make you start breathing faster in order to meet this new set point. You breathe faster, and your tissues are once again properly perfused.
Of course, you are still burning nutrients at a faster rate, and eventually you’ll exhaust that supply as well. Eventually, you will tire out. This brings us to allostatic load, namely the wear and tear that happens on your body as it tries to meet allostasis. Allostasis requires pushing our body outside of a state it can easily maintain. The longer our body is forced to maintain allostasis, the more the cost, and eventually, we burn out. Maybe we collapse to the ground, heaving and trying to recover our breath. Maybe we get sick. Maybe we have a heart attack. Or a panic attack. Maybe we develop anxiety, inflammation issues, depression.
But not from jogging.
Let’s then consider our body’s excitatory ready mode, popularly known as the fight-or-flight state. When your body senses danger, the primary stress hormone released is cortisol from the adrenal glands atop the kidneys. Cortisol is a steroid. Cortisol is going to want you to have energy fast, so it’s going to help break down glycogen stores into glucose, raising your blood sugar level. It’s going to suppress systems it thinks are non-essential for the immediate situation, such as parts of your immune system. (Remember that corticosteroids are used as anti-inflammatories.) It’s going to raise your blood pressure, to make sure all of your muscles and tissues can get the resources they need quickly.
So this is an allostatic state, an allostasis, that our body has moved into in order to quickly react to danger. Maybe it does it because you’re about to be eaten by a tiger. Maybe you’re about to be “eaten” by your boss, or a difficult client, or a bully. Maybe it’s an enemy soldier. Or a car accident. Or your parents.
People, especially those who are dealing with trauma, can get sort of stuck in allostasis. They have a hard time bringing themselves out of this fight-or-flight mode. Of course, over time with allostatic load, that wear and tear, the chronically stressed fight-or-flight mode itself becomes damaged. It doesn’t function quite the same anymore. Plus their body is having to deal with this allostatic load over years, maybe decades. The body may start having blood sugar issues, weight issues, hypertension, heart problems, neurological problems. The person may be considered “high-strung” or have chronic anxiety. Maybe they have a short temper. Maybe they resort to drugs and/or alcohol to try to calm themselves. Quite often some combination of lifestyle changes, therapy, and medication are required to get them back to a healthier state and stave off the wear and tear of the allostatic load.
Lastly, let’s consider the chronic alcoholic. Alcohol is a suppressant. Its primary mechanism is to activate our body’s natural calming system. A little bit of alcohol can do this. But drinking too much (which is essentially overdosing), and drinking too frequently moves the body’s healthy set point. The body will respond to this by releasing more excitatory hormones and less calming hormones. Given enough time, it will create more excitatory cellular receptors, too, and remove some of the suppressing/calming receptors. It is trying to achieve balance. The alcoholic in part recognizes this as needing more alcohol to relax. And so goes the downward spiral.
But then there is a moment of clarity, and the alcoholic decides to quit. So now, there is no longer alcohol in the system there to activate the calming receptors. What will happen?
If we’re only talking one night of maybe partying and drinking too much (which again, is an overdose), then that person will later have symptoms such as a fast heart rate. Maybe sweating. Maybe increased anxiety.
Why? Because their body is flooded with more excitatory hormones in order to balance out the excess suppressive drug they just saturated their system with.
Now remember that over time, the body will not only change its hormonal response, but will actually modify the cells so that they are more receptive to excitatory signals, and less receptive to suppressive, calming signals. This is the chronic drinker. When that person suddenly stops drinking, they are going to feel very bad. Their hands will shake, their heart will beat hard and fast, they will sweat, they will worry. They might become delusional.
…And they can straight up have a seizure.
All of this is known as a rebound effect. When your body is working hard to reattain a balanced physiological state by countering a drug in your system, and suddenly that drug is removed, your body will then bounce back way in the opposite direction, to an exaggerated out-of-balance point on the other end of the spectrum. And sometimes this rebound can kill. Chronic hard drinkers who quit cold-turkey without medical help often have to be hospitalized.
This is why substance abusers often have to be put on a medication similar to their drug of choice, and then tapered off. (With therapy.) This is why people who have been on cardiovascular medications and certain psychopharmaceuticals cannot just suddenly stop taking their pill, but must allow the dose to slowly be lowered over time before it’s removed. Patience is required.
And I’ll tell you something else, babies born to opioid abusing mothers? They are born with their bodies in withdrawal shock. I spent some time with these adorable little creatures, but it’s heartbreaking. They have to be maintained in the hospital, getting enough of an opioid to get their body out of shock. And they stay in the hospital, being monitored while the opioid level is steadily tapered, steadily dropped, until homeostasis is restored as well as possible.
So there we go.
Homeostasis. Allostasis. Allostatic load. Rebound effect.
