Fascinating. Yes we do need a revisit of the concept of homeostasis as a basis for good health. Bernard was right in the 19th century but the rivalry between him and Pasteur polarised the debate. This left us with an incomplete model of what is good and poor health.

This idea of course would be a major blow to the wide-scale practice of modern medicine, which today is so heavily based on preventative medicine based on ideals determined by models and scans.

Dear Barry,

Thank you so much for your comment and for your lucid historical perspective on Bernard and Pasteur. It's a fundamental point.

Your analysis is incredibly insightful. I fully agree that a dynamic, individualized approach would represent a "severe blow" to current paradigms of preventive medicine, which are often based on static models.

I have reviewed the papers you shared on personalized medicine and AI-designed drugs, and I find them fascinating. In fact, your work and mine seem to be two sides of the same coin. You seek to personalize treatment at the genetic and pharmacological levels; I seek to personalize diagnosis at the neurodynamic and phenomenological levels. We both seek to create a "map of the individual" to replace the "model ideals" you so aptly criticize.

The possibility of integrating these two approaches—the genetic map with the map of consciousness—is an idea with immense potential.

Thank you again for your valuable contribution and for sharing your work.

Best regards.

My opinion.

This will not work because there is a genetically determined Metabolon for a given period of life. It is impossible to change it by accepting any criteria until the system of its functioning changes. And as we know, it can only be changed by radically changing the lifestyle of a given subject. But this is a social rather than a scientific task.

Fedotov A.V. Doctor of Science

Dear Alexandre,

Thank you for your perspective. I value the debate because it forces me to refine the logic of my own framework from the other angles that you have been the first to address so far.

We agree that there is a fundamental biological substrate. However, your strict separation of this "scientific" substrate from its "social" modulation strikes me as a dichotomy that the biological evidence itself does not support. And herein lies my need for rigor.

You argue that lifestyle modification is a "social, not scientific, task." I wonder, then, how would you classify the psychosomatic phenomenon? When chronic social stress produces permanent and measurable endocrine changes, at what exact point did the process cease to be "scientific"? Is the cause merely "social" while the effect is "biological"? This seems like a contradiction. Biology and the decisions we call "social" exist in an inseparable feedback loop.

Furthermore, your argument seems to ignore the origin of scientific theories themselves.

The most revolutionary ideas in history didn't always emerge from a laboratory, but from deep introspection, from that "socializing with oneself." Was Einstein's mental process, visualizing his experiments in the hypnagogic state, an "unscientific" endeavor? On the contrary, it is perhaps the purest form of science. And I don't believe this can be refuted or explained solely and purely from a biological perspective, which you seem to dominate, or from a social, philosophical, or psychological perspective, which is the area in which I dominate. You can't and never will build a good building or city without good soil.

Your argument seems to reduce biology to its genetic basis, ignoring neurobiodynamics: the fact that the brain is a dynamic system that is constantly modified by what you call "the social." Separating them is like trying to build a building where the foundations and upper floors don't touch at all, which magically happened but isn't explained, but the whole is expected to stay together, hoping for a divine miracle? Here, we don't think out loud, or say it or say it, and that is indisputable and irreversible.

My work, Physicobioneurodynamics, doesn't deny biology. On the contrary, it honors and venerates it, attempting to create the tools—Neurotopological Psychometry—to measure precisely this inseparable interaction between the "substrate" and its "mathematical and scientific dynamics" thanks to what you call "the social."

I seek to create a scientific model for the social phenomenon you relegate. Because if an intervention has a measurable biological effect, then the study of that intervention and its mechanism is, by definition, a scientific endeavor.

I appreciate your comment. It has been fundamental in reaffirming that the future is not in choosing between biology or psychology, but in building the science that ultimately unifies them.

A cordial greeting.

Homeostasis, while a foundational concept in biology, has limitations in explaining the complexity of biological systems. It primarily focuses on maintaining stability within a narrow range of conditions, often neglecting the dynamic interactions and emergent properties that characterize living systems. This limitation can be addressed by adopting a new language for system dynamics that incorporates broader regulatory mechanisms and adaptive processes. Homeostasis often relies on a reductionist view, focusing on individual components rather than the interactions within complex systems, which can lead to oversimplified explanations of biological design. Traditional homeostasis emphasizes stability, failing to account for the dynamic changes organisms undergo in response to environmental stressors. Homeostasis also does not incorporate allostasis, which involves predictive adjustments to internal setpoints, thus limiting its applicability to adaptive responses in complex environments.

Instead, an integrative framework would help a lot. A new language can integrate concepts like allostasis and dynamic modeling, allowing for a more comprehensive understanding of biological systems. Alternatively, utilizing dynamic models that account for metabolic networks and their interactions can provide insights into the regulatory mechanisms that govern complex biological behaviors and thereby give us a better understanding of the beginning and end of life.

Gerry

I fully agree with your comments that homeostasis is measured by reference to a narrow, and occasionally arbitrary range of conditions. Also it is reductionist by nature.

In pharmacology the ideal is finding personalised treatments that consider dynamic changes in organisms, in particular the expression or non-expression of P450 cytochromes rather than simply the old fashioned one size fits all model based solely on the pharmacokinetics and pharmacodynamics of the drug. The present model leads to multiple avoidable adverse reactions

For the moment this is prohibitively expensive due to clinical trials remaining largely as fixed trials, which are colossally expensive. As the adaptive clinical trial becomes more acceptable we should hope that a reduction in cost will lead to a wider range of rarer diseases being treated based on the personal characteristics of the patient.

Dear Gerry,

I sincerely thank you for your comment and for sharing your perspective as such an established neuroscientist.

You have articulated the central issue with impeccable clarity. I fully agree that the homeostasis model, although useful, has severe limitations for understanding the complexity of biological systems. Your call for a "new language" that incorporates allostasis and dynamic modeling is, in my opinion, the most urgent step science must take.

Physicobioneurodynamics and my proposed map of "Dynamic Life States" (including Isostasis) are precisely my attempt to build such a language. I seek to create a framework that allows, as you so aptly put it, a better understanding of the "beginning and end of life," not as static points, but as a dynamic and complex trajectory.

Barry, thank you for joining the debate and for your excellent commentary. It's fascinating to see how you, from a pharmacogenomics perspective, and Gerry, from a neuroscience perspective, arrive at the same fundamental conclusion.

I've reviewed the papers you shared, and they seem like the perfect complement to this discussion. Your work and mine seem to be two sides of the same coin, attacking the same outdated paradigm from different angles. You seek to personalize treatment at the genetic and pharmacological level to avoid "avoidable adverse reactions." I seek to personalize diagnosis at the neurodynamic and phenomenological level to understand the "experienced form" of suffering and, in the same way, generate personalized tools for clinical and medical treatment that you master to enhance solutions to people's dynamic states and not just "one pill fits all," as my colleague Stanley Wilkin previously mentored me with his courageous and insightful work on medical, psychiatric, and scientific reductionism, with Kraepelin's history of the Nazi movement, the birth of psychiatry, and its origins.

The possibility of integrating these two approaches—your genetic map with my map of consciousness—is an idea with immense potential for a true medicine of the future.

Best regards. And thank you for nurturing this collective and latent need.

Arturo

I have added some more lecture slides which might be of interest. There is a useful chart on slide 58 indicating the problems with reductionist homeostatic models of disease from a pharmacological perspective.

Barry, I am immensely grateful for sharing your conference material. It is a gesture of extraordinary intellectual generosity that I greatly appreciate.

I have already started reviewing it, and the connection between your work on treatment resistance and my dynamic life states model is incredibly clear and powerful. Your pharmacogenomic perspective is the empirical piece that gives a "hardware anchor" to my more abstract theory of system dynamics.

You are demonstrating at the molecular level with clear evidence what I am trying to model at the topological level: that each individual is a unique universe and that treating it with "ideal models" is a recipe for failure.

It would be an honor to continue the debate and nurture this need. Thank you again for this bridge.

Best regards, and thank you for strengthening my knowledge and my mania in these topics.

Arturo is right to insist on a recalibration of central ideas and thinking, based largely on reductionism. Such ideas present efficient purpose but quickly cease to be genuinely helpful. It or they produce little apart from backing up the power of experts.

Stanley, thank you very much, as always, for your constant support and the acuity of your perspective.

You have articulated a point that is absolutely fundamental and often overlooked: the role of reductionism as a mechanism that "supports the power of experts." Your analysis is surgical and reveals the ethical and social dimension of the problem.

Precisely for this reason, my proposal for Neurotopological Psychometry is not just a technical tool, but an ethical one. It seeks to create a bridge where the quantitative "map" of the neuroscientist and the phenomenological "legend" of the patient have the same epistemic status. The goal is to force a dialogue that dismantles this power structure and validates the "lived form" as an irrefutable source of knowledge.

It is a true honor to count on your lucidity in these debates.

Best regards.

I cannot leave this without referencing my research into psychiatry and the processes of legitimacy it engages in and has from the time of Kraepelin in the late 19th century. The production of narratives as evidence for illnesses authoritated by the psychiatric profession. The doctor provides a narrative of a type of mental illness, provides evidence that certain behavior is evident of mental illness, without context and with only the doctors assertions as evidence. THERE IS NO CONTEXT USUALLY ALLOWING FOR THE PHYSICAL PROPERTIES OF MENTAL ILLNESS TO BE EMPHASISED. It is the doctor's voice and the evidence and treatments lie within a rhetorical framework. The evidence produced is within this framework and once you or anyone else shakes their head and searches for independent evidence, that is empirical evidence outside doctor's claims, there is none.

All evidence assumes a narrative form occasioned by the profession.

Arturo,

As valuable as your tool will be the dangers remain of placing the narrative in the hands of a single group with a defined history. A therapist friend of mine on here recently published a short paper on the identifiable and identified traits of a new prognosis. At first I was convinced but I read it again and began to detect the narrative. Opposing and contrasting viewpoints based on power differential, for example, with the medicos presenting and surveying reality and the patient unable to do so. Reality was and is solely in the hands of the doctor. A new mental illness was identified with a flurry of new definitions. The definitions help the narrative and convince the casual reader. They act as chapters or subheadings within a well constructed story.

I noticed this within works on psychopathology. The doctor determined who was the psychopath and who was not, and of course it was never them. Why not? The doctor engages in a narrative within the context of identity change the doctor never suffers, the doctor is a doctor is a doctor is a doctor. The identity is fixed. The patient can be mad, then sad, then docile, then dangerous, the condition fixed individually and also within a group without philosophical analysis, are human beings violent and what purpose did violence serve, are all the participants in Palestine and Ukraine psychopaths, because of their actions and intentions? The versions of reality of the doctor subvert and compromise all other possible and legitimate realities.

Context, narrative, conclusion are all accepted without concern for any other possibilities, that is the writer made large areas of the narrative up.

Stanley, thank you so much once again for your profound contribution and for bringing the debate to this level of critical analysis. Believe me, I've reread your comment again and again, trying to find a strategy that, no matter how complex, is and can be possible with the advancement of technology.

Your analysis of psychiatry and the "production of narratives as evidence" is brilliant and necessary. I fully agree that the profession often operates within a self-contained "rhetorical framework" that defines both illness and evidence, often excluding the "physical properties of mental illness."

Your argument, in fact, gets to the ethical heart of my proposal. As you already know, Physicobioneurodynamics seeks to reintroduce those physical properties through dynamic biomarkers. But nothing is simple, and this is where your warning is crucial. I fully understand the danger of "the narrative remaining in the hands of a single group."

It is precisely to avoid this that Neurotopological Psychometry was designed as a mixed approach. The intention is for the quantitative "map" (network entropy, fractal signature) and the phenomenological "legend" (the patient's first-person account) to have the same epistemic status. The objective is to force a dialogue that dismantles this power structure and validates the "lived form" as an irrefutable source of knowledge. But it's not just that the "doctor" has the power to distort the results, because that would be justifiably punishable and objectionable. New types of laws or norms are needed to safeguard professional-patient confidentiality, and for the patient to have the right to know and request or demand how their treatment is being performed, thereby delivering genuine results as soon as they are formalized. In this same way, the person will have the qualitative and quantitative results in their almost human form, considering that for the following month their dynamics will change again and a different therapy will need to be reformulated, as in psychology every week, every month, or every six months. But the point with this is for the patient to understand their internal experience, which is always in constant change, and although most may not be able to understand what these results say, to mobilize the assisted AI of expert professionals in the field who can jointly explain to the patient what is happening in their internal experience, discarding most of the biases that, by nature, psychiatrists, doctors, neurologists, psychologists, etc., cannot master explaining separately.

Therefore, your perspective is invaluable. You remind me that the goal is not just to change the map, but to change the power relationship between the cartographer and the inhabitant of the territory.

Thank you for your vast experience in these debates. It forces me to consider more sociological, functionalist, and ethical solutions so that it doesn't spiral into another kind of modern reductionism.

"I fully agree that the profession often operates within a self-contained "rhetorical framework" that defines both illness and evidence, often excluding the "physical properties of mental illness."

It is not the only branch of medicine that operates on that model. Having worked in endocrinology research and in the mechanism of cancer metastasis I have seen 'self-contained frameworks' used in the absence of evidence on a number of occasions.

Barry I agree and that's why medicine should come under scrutiny, all of it not simply psychiatry. The structure of delivery, claims, intellectual and information control needs to be reconsidered.

This is from a forthcoming paper of mine and fully displays the harm done by psychiatry for at least two centuries emphasising the modules of power individual psychiatrists possess and their control of reality. Psychiatry functions within a state of belief and control over reality.

The nature of psychiatric diagnosis is seen by many as an alien form of classification (Barker, Phil. Psychiatric diagnosis. Mental Health Ethics. Routledge, 2010). As Barker points out:

All medical diagnoses begin with a hypothesis, based on the physician’s observations of signs of possible illness, displayed by the body, and symptoms reported by the person. The formal diagnosis – especially where the condition is severe or life-threatening – is dependent on pathological corroboration. After examining me, the physician may believe that I have swine flu (H1N1) but would need the results of a laboratory test of a viral culture to confirm this. If my condition appears related to a more complex, or rare disorder, the physician might need to call on the support of radiographers, toxicologists, pathologists or other medical scientists, to confirm the diagnosis. By contrast, if I go (or am sent) to a psychiatrist complaining of troubling thoughts, feelings or patterns of behaviour – or indeed if a member of my family views any of these as troublesome – a psychiatrist may decide, on the basis of an interview, that I have a psychiatric disorder. None of the blood tests, urine tests, X-rays, biopsies or computerised body scans, commonly used to confirm a medical diagnosis, will be used to help confirm the presence of my ‘illness’. Although I may be interviewed several times, in principle a single conversation with a single psychiatrist is all that is necessary to judge whether or not I am ‘mentally ill’. However odious the comparison might seem to psychiatrists – if not other mental health professionals – all psychiatric diagnosis is mere opinion, based on the professional’s ‘powers of observation’. These are the same ‘tools’ used by the art or theatre critic, or the judges in boxing or gymnastics. Of course, these critics and judges might be described as experts, having witnessed hundreds if not thousands of ‘performances’, and their judgement might carry considerable authority. However, the audience, the general public and the performers are free to disagree. Indeed, time will tell whether these opinions were flawed if not actually ‘fixed’. However, because a psychiatric diagnosis is made by a doctor it is assumed to relate to an actual illness.1 In that sense, it is nothing like judging the results of a boxing match. If those judges make errors of judgement, or even ‘fix the fight’, the loser can still fight again later for another title. By contrast, if I am judged to have a psychiatric disorder, this may (indeed likely will) affect, among other things: my freedom to travel internationally; my career opportunities; my chances of adopting or fostering a child; or even my right to cast my vote in an election. Unlike sports, making a comeback from a psychiatric diagnosis is fraught with many more complications.

I appreciate these comments (all of them) and I am proud to find them on research gate. I have other questions on homeostasis that I will try to formulate later on. My starting point has always been that any stability must be challenged to become a stability.

Thank you all to encourage reflections on homeostasis.

Francoise Schenk