A companion piece to Martin Picard’s “Energy: The Missing
Dimension of Biomedicine”
Martin Picard and I started with the same image.
A candle flame. Not a thing — a process. A pattern of energy flow that maintains itself by continuously consuming fuel and exporting waste heat. Stop the fuel, and the pattern collapses. Not because the flame was damaged. Because the process that sustained it was interrupted.
In his recent Nature essay with Christopher Kempes, Picard argues that biomedicine has built its entire edifice on the wrong foundation. We’ve been treating bodies as molecular machines — collections of parts that break and need fixing. But a living body is not a machine. It is an energy process. The difference between a living person and a cadaver is not the genes, the cells, or the organs. It is the flow of energy through the mitochondria. You are the flame, not the wax.
I’ve been making a version of this argument for twenty years, from a different direction and toward a different destination. The Evolutionary Stress Framework begins in the same place — the body as a dissipative structure, a Prigoginian pattern that holds its improbable order by burning through energy — but it follows the thread somewhere Picard hasn’t yet gone. Into the question of whose flame, and what happens when different flames have different physics (ala Neurodiversity).
This is a companion piece, not a critique. Picard’s work is foundational for what the ESF is doing. But there are things the ESF can see from its particular vantage point that the energetic framework, as Picard has articulated it so far, hasn’t yet addressed. I want to name three of them.
1. Energy is not one budget. It is a coordination problem.
Picard’s central insight is that illness is an energy sink — that disease costs energy, forcing trade-offs that constrain how a person can function. This is exactly right, and it’s what allostatic load research has been documenting for decades without quite naming it in energetic terms. Picard names it.
But the ESF adds a layer: the energy cost that matters most is not the total amount of energy consumed. It is the cost of coordination.
Your body doesn’t just burn energy. It coordinates energy expenditure across multiple regulatory channels — cortisol, immune signaling, autonomic tone, metabolic regulation, sensory processing — all of which must stay in conversation with each other. The ESF calls this coherence, and measures it as mutual information between channels. When coherence is high, the channels are coordinated: knowing the state of one tells you something reliable about the state of another. The system is organized. It’s efficient. Energy is being spent on maintaining a pattern that works.
When coherence degrades — when mutual information between channels declines — the system doesn’t just lose energy. It loses organization. The channels stop talking to each other. Each one may still be functioning, but the coordination breaks down. Joint entropy rises. The system starts visiting configurations it shouldn’t be in.
This is stress incoherence. And it is energetically expensive in a specific way that total energy-budget thinking doesn’t capture. You can have two people spending the same total metabolic energy, one coherent and one incoherent, and the incoherent one is in far worse shape — not because they’re spending more energy, but because the energy they’re spending isn’t buying coordination.
Picard’s five questions for an energetic lens on biomedicine are good. The ESF would add a sixth: What is the coordination cost of maintaining this function, and what happens to inter channel coherence when the coordination budget is stressed?
2. Not all flames have the same physics.
Here is where neurodiversity enters the conversation, and where the ESF diverges most sharply from a typical energetic framework.
Picard writes about energy as though bodies differ mainly in how much energy they have, how efficiently they use it, and how illness redistributes it. The ESF proposes something more fundamental: bodies differ in how many regulatory channels must be kept in coordination — in the dimensionality of the coherence problem they are solving.
The ESF calls the two broad ends of this spectrum neurosocial and neuroperipheral. Neuroperipheral systems — the regulatory architecture associated with autism and related profiles — process more raw signal from the body and the environment. More sensory data. (Hogenkamp et al. 2026). More autonomic fluctuation. More interoceptive input. More channels contributing to the regulatory state space across which mutual information must be maintained.
This is not a deficit. While these systems might be thought of as high-entropy systems – They are actually better described as high-precision systems — maintaining lower internal entropy, higher mutual information, more structured coordination across more channels — at higher energetic cost.
And this means the thermodynamics of their flame is different. Not worse. Different.
The coherence tax — the ESF’s term for the additional energetic cost of maintaining coordination across a higher-dimensional regulatory state space — is real, measurable, and consequential. A neuroperipheral (often identifying as neurodivergent or having an autistic profile) system maintaining coherence across twelve strongly coupled channels faces a harder thermodynamic problem than a neurosocial system maintaining coherence across seven. The potential entropy is larger. The energy budget for coordination is tighter. The margin for additional perturbation before coherence degrades is narrower.
Picard’s energetic lens is powerful. But if it doesn’t account for the fact that different regulatory architectures face structurally different energy landscapes, it will reproduce the same error that molecular medicine made: treating all bodies as though they face the same problem at different intensities, rather than recognizing that some bodies face a fundamentally different problem.
When Picard writes that “illness costs energy, forcing trade-offs,” the ESF asks: which trade-offs, for which architecture, in which environment? The answer is not the same for everyone, and the difference is not just quantitative. It is geometric.
3. The survival setting is not a breakdown. It is an energy allocation.
This is where Picard’s framework and the ESF’s pathology reframe converge most powerfully, and where each strengthens the other.
Picard argues that when you’re sick, you can’t be your best self — that disease saps energy and constrains function. The ESF sharpens this: under chronic stress, the body doesn’t just lose function. It reallocates. It shifts energy toward survival-priority systems and away from everything else. Immune activation takes priority over cognitive flexibility. Threat detection takes priority over social engagement. Maintaining basic autonomic stability takes priority over interoceptive nuance.
This is not a breakdown. It is an organized response to an energy emergency. The body is doing exactly what a dissipative structure should do when the energy budget tightens: it narrows the pattern it’s maintaining, sacrificing breadth for viability.
But — and this is the critical ESF insight — these survival allocations can stabilize. They can become attractor states. The body finds a configuration that preserves immediate viability under chronic threat and then gets stuck there. Hypervigilance. Shutdown. Compulsive rigidity. Dissociation. These are not chaos. They are costly, brittle order — regulatory strategies that are highly organized but narrow, metabolically expensive, and resistant to change.
Picard’s energetic framework explains why this happens: illness is an energy sink, and energy constraints force trade-offs. The ESF explains what happens next: the trade-offs stabilize into self-reinforcing patterns that persist even after the original energy emergency has passed.
This means intervention cannot simply restore energy. You can give someone better nutrition, better sleep, better mitochondrial support — and if the survival allocation has stabilized, the additional energy may be captured by the rigid pattern rather than restoring flexibility. The attractor state doesn’t dissolve just because the energy budget improves. It has to be destabilized — which requires reducing the chronic uncertainty that keeps the system locked in survival mode, improving the predictability of internal signals, and reshaping the environment so the system can safely explore broader regulatory configurations.
Picard’s framework tells you to restore the energy. The ESF tells you to also widen the envelope — to create the conditions under which the system can use that energy to rebuild coherence rather than sustain rigidity.
The convergence
I want to be clear about what I’m saying and what I’m not.
- I am not saying Picard’s framework is wrong. I am saying it is right and incomplete — in the way that all good frameworks are incomplete because they are looking at one dimension of a multidimensional problem.
- Picard sees the flame. He sees that biomedicine has been staring at the wax and ignoring the fire. He sees that energy is the missing dimension, and he’s publishing in Nature to say so, which takes courage and matters enormously.
The ESF sees the same flame and asks three additional questions:
- 1. What is the coordination cost of maintaining this particular flame — not just the total energy, but the mutual information budget across regulatory channels?
- 2. Do different flames have structurally different physics — different dimensionality, different coherence costs, different bifurcation boundaries?
- 3. When the flame narrows under stress, does it stabilize in a narrow configuration that persists even when energy is restored?
These are not competing questions. They are layers of the same question. And they converge on the same conclusion Picard is reaching: biomedicine has been treating bodies as machines to fix, when it should be treating them as energy processes to support.
The ESF just adds: …and different energy processes in different bio -neurotypes and emergent neurotypes need different support, because their physics is different. And restoring energy is necessary but not sufficient, because the body may have organized itself around scarcity in ways that don’t automatically dissolve when abundance returns.
We’re looking at the same candle flame. We’re just seeing different things in the flicker.
What comes next?
Picard’s Nature essay with Kempes proposes five questions that scientists should ask about any system they study. I’d love to see a conversation about what happens when those questions are asked differentially — when the energy costs, the competing processes, the constraints, and the trade-offs are not the same across regulatory architectures.
The ESF has been building the scaffolding for that conversation. Picard’s lab has the mitochondrial data. Somewhere between his MitoBrainMap and the ESF’s coherence framework, there may be a way to measure what the coordination cost actually looks like at the cellular level — to see whether different bio-neurotypes really do face different mitochondrial energy landscapes, and whether the coherence tax shows up in the mitochondria themselves.
These and many more collaborations and across-field communications waiting to happen through the language of stress, energy and neurodiversity.
Martin Picard’s “Energy: The Missing Dimension of Biomedicine” was published on his Substack (March 17, 2026), accompanying Picard & Kempes, “From cancer to Alzheimer’s: could a renewed focus on energy transform biomedicine?”, Nature (March 10, 2026).
This essay reflects the perspective of the Evolutionary Stress Framework (ESF), a conceptual lens developed by the Center for Adaptive Stress. Its claims are offered as theoretical propositions and hypotheses for investigation — not as established clinical conclusions or medical advice.
Lori Hogenkamp is an autistic independent scholar and founder of the Center for Adaptive
Stress. She writes at evostress.blog and @peripheralminds.
Hogenkamp, L., Sanghavi, D., & Natri, H. Toward an Emergent Paradigm for Neurodiversity and Health. Autism in Adulthood. https://doi.org/10.1177_25739581261433443
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