Originally written on June 24, 2019
Some time ago, as a friend and I were chatting about the nature of chronic illness, I mentioned my idea of a "threshold theory of change". At their prompting, I sat down to write a short description, and this is what poured out. I'm certainly not the first person to frame change this way. The diathesis-stress model comes close, as does Nassim Nicholas Taleb’s “antifragile” concept. The dynamics of "allostatic load" also describe some elements of this natural phenomenon. It's simple, and intuitive, and yet decidedly counter to our enculturated patterns of thought. What I describe below can be a helpful, deeply hopeful, and compassionate shift of orientation about how change occurs.
I call it the Threshold Theory, though I don't think of it only as a theory, but rather a heuristic, which is “any approach to problem solving, learning, or discovery that employs a practical method, not guaranteed to be optimal, perfect, logical, or rational, but instead sufficient for reaching an immediate goal. Where finding an optimal solution is impossible or impractical, heuristic methods can be used to speed up the process of finding a satisfactory solution.” (Wiki). Does this sound familiar? I recognize that this circles back to the definition of a theory: a hypothesis to be tested by lived experience, and never proven. This is a core principle of the scientific method, but for my purpose here it is not truly testable short of a massive, multivariate analysis of a mix of quantitative and qualitative data, for which we as yet lack the scientific tools. Philosophy, and psychology, with their contemplative, relational, and experiential ways of knowing, will suffice.
The Threshold Theory offers a way for us to rethink how we go about planning, prioritizing, and taking steps to help ourselves or our clients to heal, or to express our authenticity more fully in our lives. It starts with the idea, which I believe is universally true even when there are major emotional and physical health problems, that our bodies are self-healing and optimizing. I prefer to think of us as self-correcting and balancing ecosystems within larger ecosystems, and in intimate relationship with even smaller ones. Think of the microbiome, for example. Deciding what factors go into that optimization is far beyond our current ability to quantify. It is massively complex, time dependent, includes feedback loops, and effects which depend upon combining in a certain way with other factors (in genetics, these would be “epistatic” effects). As a result of this formidable conceptual challenge, and due to broader historical and cultural factors, cause and effect are normally understood as linear, where A precedes and causes B directly (or not), end of story.
For example, most medical doctors and psychotherapists trained in the medical model look for a single cause of our illness, or a few factors at most, and treat it once, stop when it fails to produce results, pick another target, fail, stop, and again. “Lifestyle factors” are important and constantly repeated by our beleaguered physicians, but to little avail. If the drug treatments and surgical interventions don’t work then far too often the problem is considered to be “psychological” (anxiety, to be specific). The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is built around this. This happens because we (doctors and patients alike) have been trained in a model of illness that was, at least in part, a response to the sorts of infectious diseases that were killing people from the time we settled down into agricultural communities on forward. Something different is currently in order.
Now many of our most challenging and “epidemic” health problems (including “mental” health) are complex, ongoing, and multi-systemic, where the disease model and the current limits of the scientific method for identifying causes and treatments are wholly inadequate. In medicine, if you can’t see it on a lab report, it probably can’t be treated. Quantitative scientific methodology works primarily on phenomenon that can be reduced to a few variables that may be causally related, or even just randomly correlated. These methods are beginning to be more capable of addressing complex systems, via increased computing power, often huge data sets, and complex algorithms, but it's still very limited, and largely unverified. Nutrition research is notoriously difficult for this reason. There are too many variables that can’t be controlled for research in this field to be able to say anything truly reliable. Even animal models, which control for so much, are inadequate (setting ethics aside).
That leaves us with the Threshold Theory and a good dose of common sense. By “common sense”, I mean self-awareness and trust in what we each sense to be true based on intuition. To be even more transparent, I consider “intuition” to be the integration of all our ways of knowing, including our observations and experiences of cause and effect over time.
I propose that one of the best ways to support change is to recognize that the process of becoming ill depended on the accumulation of a lot of variables, encoded in our physiology across countless generations, and many of which our bodies accommodated while remaining reasonably functional. Current research with animals shows that epigenetic changes can persist over 14 generations, and DNA expression can change within an astonishingly short time (hours!). These changes are thought to be caused by prevailing environmental conditions, including trauma, relationships, scarcity, safety, temperature, and anything which benefits enough from adaptation. We are subject to the same adaptive forces, which some evolutionary biologists and geneticists like Dr. Eva Jablonka believe become part of our DNA over time, and which would add an important chapter to evolutionary theory.
Given the myriad insults to our embodied being, our capacity to adapt and continue to function is astonishing. Depending on family, community, race, and broader historical factors, those inputs accumulate over time and are balanced within our complex systems (body, mind, spirit, and even the natural ecosystem), until the balancing process becomes too burdensome and we cross a threshold, often quite suddenly, into a serious, multi-systemic, adaptive illness state, whether of the “body” or of the “mind”, which are inseparable. This is the heart of the Threshold Theory, as well as of some new theories about epigenetics and evolution (see Dr. Eva Jablonka, in references), and even of a new theory of life (see Jeremy England, in references).
This illness state is not a sign of being “broken” or “dysfunctional”. It is evidence of our adaptation to the multiplicity of factors across time, and certainly well before we were conceived. It is natural wisdom. Our prior health was also indicative of the cumulative adaptations of our lineage within the environment of their time. Stability over time is indicative of homeostasis, which is the state our body wants to be in, one of continuity and moderate adaptations to inputs like stress, toxins, environmental changes, viruses, etc. Allostasis is the shifting that occurs on the way to a new state of stability, while hormesis is at the heart of the “anti-fragile” concept of Nassim Nicholas Taleb, mentioned above, and is about our adaptations to stress which leave us stronger and more well-suited to our environment via the resilient management of our allostatic load. They all work together, seamlessly, but with bumps we very well know about, and which we know of as “symptoms”, and which can be life-altering and horrible.
This dynamic of stability and change describes how we can seem to be “OK”, and then get overwhelmed to the point of having truly awful experiences, some of which cannot be rebalanced in our lifetime. It is there that the disease model and the Western paradigm wreak havoc. In our desperation, and from the limitations of our culture, we typically look to final events for the “cause” of our suffering, rather than understanding it in an embodied (integrated body, mind, ecosystem, and spirit), and holistic way. That said, most people know that it wasn’t picking up the lint off the floor that made our back go out, to offer a classic example.
It took a lot of inputs and body/emotion/ecosystem adaptations, including our relationships and early childhood attachment experiences, to reach that tipping point, but tip we do. Now that we’re sick, or depressed, disconnected from consensual reality, or whatever the magical combination of adaptations results in, our body then resists change because of the forces of homeostasis. Gaining momentum to shift into larger scale allostasis to cross the threshold (umph!!!) into a new state can take a lot of patience, determination, and time, which I know will not be news to anyone trying to heal body, mind, emotions, and ecosystems (our embodied being). This movement takes a steady accumulation of new adaptations, none of which can be predicted exactly.
This brings us to the most important, and not immediately intuitive implication of the Threshold Theory. Given the alchemical, complex, time-dependent, hugely diverse array of factors which make up our embodied experience of being, how in the world (literally, the whole world) do we figure out how to reduce suffering and live more fully?
The implications of the Threshold Theory are that we are tasked with identifying the major factors involved, deciding which ones we actually have a choice about (economically, practically, politically, emotionally, etc.), prioritizing our next steps, and beginning to push on the biggest “levers” that are within our reach, and that are likely to have the greatest influence on our outcomes. These can usually be found with common sense, personal experience, a bit of research and help (if possible), and a minimum of trust in our own self-knowledge. This last is a particularly important part, which requires valuing own experience and gut feelings enough to not give away our authority, and the power of self-knowledge. The social justice implications of this are profound. Having tools to critique the limits of the medical model and the lens of the scientific method, and availing ourselves of systems thinking and the Threshold Theory can be very empowering. Everyone’s resources are different. We start right where we are.
The next step is crucial in the Threshold Theory: in order to build towards a threshold shift we stick with most changes whether they make any discernible difference or not. This is the part that is probably the most counter-intuitive, given how we’ve been taught to think about what causes change. We wouldn’t be wise do this with things that could harm us – so don’t – but we can be as thoughtful, deliberate, and informed as is possible. We pick the things that may not make an immediate difference, but that we’re reasonably certain are good for us, and then plan to do them pretty much forever. Some interventions will have a different pattern or shorter time frame, like some nutritional supplements, alternative medical treatments, or conventional medicines, and even they sometimes only seem to help for a day or less (think of your last, wonderful massage, for example). Some will make a positive difference in the short term, play their role, and then need to be stopped. With the right support we can make informed guesses about those. An example of this could be a ketogenic diet, which can be amazing for some people, and often shifts the system in a short amount of time, and then once the underlying conditions are different it may need to be stopped or altered. The key to the Threshold Theory is that the underlying conditions are constantly changing, so our “inputs” always land in different terrain.
As we create the conditions for change to occur, the order of our interventions may matter. However, figuring out that order is likely to be very difficult at the least, or even impossible. For example, healing and balancing the gut microbiome may need to happen for another intervention (including counseling, or medications) to have the desired effect, where they had no effect (noticeable or not), while the microbiome was out of balance. Perhaps nutrition had no effect when the stress load was really high, but it may be that final straw towards healing at another time. The inverse can also be true. Perhaps we could tolerate poor quality sleep when the load of ecosystem stressors was lower (like toxins, or not enough time away from the city, soaking in the rhythms of nature), but it can become the final element to push us into illness at another time. There are also complex developmental factors to consider, having to do with our age and/or our phase of life.
The important lesson here is that just because it was the last thing that happened doesn’t mean it is “the cause”. The near impossibility of figuring out this issue of “order” (of treatments, changes, etc.) throws us back on the beauty of a heuristic; look back at that early definition. You don’t need to know the precise elements of the system to do what you can to create the conditions for change. Pick the biggest levers, the ones within reach, the ones that honor and respect the realities of your life, and do what’s possible, rational, and also importantly, do what is compassionate and kind.
The Threshold Model shows us that our adaptations, whether towards “health” or “suffering”, are moved by the brilliance of our embodiment in the effort to fulfill our potential as living beings, perhaps even driven by the fundamental movement of life itself (see Jeremy England in the references for more on this). Our bodies never did fail us, and were never dysfunctional, but have been endlessly adaptive and creative. What if we never asked "what's wrong with you?", but asked, "what about your world is pulling your embodied being into this adaptation?" Finding reasons for faith in ourselves (body/mind/spirit) can offer enormous relief, and a source of much-needed self-compassion.
In this way we create the conditions for change, and allow our bodies time to shift, adjust, find a new and slightly different homeostatic state that takes that input into account. The mantra is, “I am creating the conditions for change to occur”. Nutritional changes are a good one for most, though not all, of us, and may even offer immediate relief to some. For others it’s more important to address our relationship with food and body image. Here’s the crux: for those who didn’t experience any relief from nutritional changes, it’s still a significant way we can create the conditions for change. You just can’t know until all of the factors have had time to adapt in relationship to dynamic underlying conditions.
This is why it’s helpful to think of ourselves as ecosystems within ecosystems, because it’s all related, and system adaptations take time. It can take years, and I know many of us are so miserable that this can be hard to fathom, and it may be what makes us want the doctors to be right, and to try one more, new “treatment”, hoping we don’t have to make these life changes and stick with them forever (often, but not always). I’m guessing many changes take about two years to be fully integrated into our systems. This number is based on my intuition (the integration of all of my ways of knowing), but I think it’s likely. Some steps of the adaptive shift can happen more quickly, as we create the conditions for more, deeper, and significant changes. I believe that sometimes the deepest changes that cause the whole world to shift in ways that we couldn’t imagine before come from relationships, whether personal ones with families or partners, or with just the right counselor (shaman, wise elder, psychotherapist, mentor, etc.). They may come from doing personally meaningful work. They may come from loving an animal, or something else that gives us deep joy and a sense of belonging.
What are the biggest levers for change, whether towards even deeper sacrifices of life force and resilience, or towards health and fulfillment? They include nutrition, sleep, restful play, avoiding toxins (mold, endocrine disruptors, other chemicals, etc.), reducing stress, addressing the many types of trauma in an embodied way (intergenerational, prenatal, developmental, chronic, acute), attending to our subjective experience of the built environment (our electronic devices, cities of concrete and plastic, combustion engines, lighting, EMFs, noise), finding good enough medical care, altering thought patterns, behaviors, and associations to shift neural pathways, spending time in nature, cultivating safety, love, touch, meditation or any experience of presence, balancing the microbiome, touching the earth, inviting intuitive movement, and much, much more. In the short and the long term, epigenetics will change, altering our own experience and that of future generations. It may be that the first, and most important lever is your own belief that your embodiment is courageous, adaptive, working optimally under challenging conditions that we don’t understand, and this beautiful and brilliant being is you.
Consider too, that different interventions, whether specializations within manual therapy, oriental medicine, psychological theories and methods, medical models of health, and other belief systems, are all ways of seeing (heuristics) which reveal different dimensions of what it means to be a human within the broader ecosystem. All are limited, all are designed to reveal some things while obscuring others, all are expressions of the practitioner, the “patient”, and the interpersonal, neurobiological nature of their relationship, and most have value in what they contribute towards our holistic understanding of being. As pieces in your adaptive process, what may be of service to you at one time may not be at another, as the underlying conditions change. These belief systems and practices are lenses, models, and a scaffolding for our minds to organize meaning upon. By adding layer upon layer of these lenses through our experiences we form our own ideas of what’s going on, and we grow our highly personal, multidimensional map of what we are.
I see the Threshold Theory as offering a very humane conceptualization of being, suffering, and change. Within it, we can speak in terms of what’s possible, how beautifully the body has adapted to stressors across the years, and how amazing it is (we are) at arriving at the most brilliant adaptations given the nature of our lives, and those of our ancestors. Our growing understanding of the autonomic nervous system, of attachment theory, polyvagal theory, the microbiome, neuroplasticity, epigenetics, and even physics are some of the rich ways, among many, to reveal and honor the wisdom of the body, mind, and spirit in the face of mounting challenges. We all know that some of our most painful adaptations cannot be undone. Personally, I will never heal some injuries, but I do all I can to create the conditions for this amazing ecosystemic being of mine to heal, and to offer my work towards the fullness of my flowering as an inheritance to future generations of life. It’s all I can do. It’s all any of us can do, while science reinvents itself for the dawning realization that everything is connected. The universe, and our place within it, is an ecosystem.
References
Eva Jablonka: https://en-humanities.tau.ac.il/profile/jablonka
Charles Eisenstein: https://charleseisenstein.org/
Nassim Nicholas Taleb: https://www.fooledbyrandomness.com/
Jiddu Krishnamurti: https://kfa.org/krishnamurti-biography/
Vagus Study Group: https://www.facebook.com/groups/723211751156542/
Epigenetics