flexible patterns to deeply entrenched multi-system
multi-system
dysfunction. We also
discussed why applying early stage
approaches indiscriminately across all
stages can not only fail but risk
retraumatization and further harm.
And now here we turn to the half of the
matter. What happens in the brain, body
and psyche as chronic illness deepens?
And also why recovery is always possible
even in the most entrenched cases like mine.
[Applause] [Music]
[Music]
At the center of mind body
illness is the brain's threat detection
and regulation system. And in early stage
stage
illness, illness begins often with the
brain misinterpreting benign signals
like muscle tension or mild pain,
dizziness as dangerous.
And this happens because we might
already be in a stressed and
disregulated state. Um, the alarm is
quietly going off under our awareness
and it's searching for the source of
apparent danger. It mistakes and
attributes whatever is most in evidence
as as the source. And this then triggers
protective responses, inflammation,
um, uh, immune system
activity, hypervigilance and emotional arousal.
arousal.
So early stage interventions as we said
like pain reprocessing therapy,
emotional awareness, expression
technique, brain retraining and CBT and
the sea sano model works very very well
for this works brilliantly because the
neural pathways are still relatively
flexible. the prefrontal cortex and
brain the brain's regulating center can
be re-engaged
uh to into downregulating the overactive
act overactive amydala which is the fear
center and restore balance. It can
override what's coming up. We still have
the capacity to do that.
But as the illness persists or
escalates, as life becomes more
stressful, um environments to continue
to add to an already at capacity load,
something deeper starts to happen. And
research by experts such as Daniel
Seagull, Norman Deutsch, Steven Borges
and Vessel Vanderolk show that chronic
threat exposure whether from physical
injury, infection, abuse, bad
relationships, uh your job, financial
stress, bereiement, etc.
um medications just overwhelming life
responsibilities can well lead to
adaptive and ultimately maladaptive
changes in the brain and body.
The prefrontal cortex begins to shrink
under chronic stress, weakening its
regulatory influence. Daniel Seagull's
work. And the amydala becomes
hyperactive, perpetuating, scanning for
danger and amplifying symptoms from
Norman Dog's work. The anterior singular
cortex and insula become
oversensitized and they start starts to distort
distort pain
pain
and it starts to
over interpret the pain of the emotion
and bodily awareness and this is this is
the work of Steven Pes.
So the the autoimmune nervous the the or
autonomic nervous system and the immune
system become locked into chronic
disregulation and this manifests as
a persistent
inflammation, persistent activation,
autoimmune flare-ups, profound fatigue. Um
Um
functional they the brain and as as as
Bessel Vanderulk uh's work shown that
brain imaging studies of patients with
CFSME fibrod and
other chronic conditions consistently
reveals there are patterns of altered
structure and function in our
brains. But don't worry because one of
the most important concepts to
understand is that that chronic
illness is reversible
reversible
and it is about evoking self-perpetuating
self-perpetuating loops.
loops.
It's about cycles into which the body
and brain keep reinforcing each other,
keep reinforcing each other signals
signals of distress. you know, one
begets the other and it just loops
around. This is known as a functional
functional biological feedback loop. And
here's how it typically unfolds. So in
the initial trigger might be as I said
so a biological event like infection so
uh Lyme disease or long COVID antibiotics
antibiotics
medication toxic exposure mold chemicals
or or
injury and this activates the body's
natural defense systems inflammation
immune response and nervous system
alarm nervous system activation is
obviously, you know, the is is is the
brain's threat detection system is is
ramping up
and so the nervous
system replies accordingly and
especially this this alarm is on in the
amydala and related circuits leading to
hypervigilance, fear, physical tension
and bracing in preparation for defense
But in prolonged activation which we're now
now
in even after the phys physical trigger
has resolved eg the infection has has
cleared the environment has changed the
relationship has ended you've you've
taken yourself away from that initial
stressor the brain and body still retain
the memory of danger as an underlying
alarm is still going
off. And this learned pattern continues
to fire the nervous systems the nervous
systems signaling alarm to to the brain
and it keeps the immune
system activated in an in in a in a in a
hyper state. And this overactive signal
of sympathetic arousal is
ongoing which in time creates real
physiological consequences. Chronic
inflammation, immune dysfunction, uh
dysregulation, hormonal imbalance and
sustained symptoms like pain, dizziness,
fatigue, cognitive dysfunction and hyper sensitivity.
sensitivity.
As the alarm is still on
and this response has not completed, it
just becomes
constant. And over time, this loop
hardens and hardwires into a system,
which is making it increasingly
difficult to break without precision
guided intervention, which is why you
can't just say, "Oh, you're safe. There
is no stressor. It's completely fine."
It does not work when we start to
develop later iterations of the of the
condition. So Norman Deutsch describes
this as brain's capacity to learn pain
and learn dysfunction just as it can
learn anything because it is a a
meaning-making machine. It is always
waiting to be
instructed. But this is a default
mechanism we don't don't want the
consequences of. So where protective
patterns of activation basically um have just
just
become a learned habit that we've you
know they're adaptive in the short term.
We need them but over time they've become
become
maladaptive. And this helps explain why
we may continue to experience profound
symptoms long after the initial injury,
infection, trauma, relationship or life
event is over. And why brain retraining
or CBT uh any of these these modalities
alone whilst powerful at earlier stages
So beyond the brain and body, chronic
illness also has a deep psychological
and emotional dimension that we have to
acknowledge beyond all but more the the
the mild to moderate manifestations of
the conditions. And Carl Young, his
shadow concept is crucial for
understanding why some illnesses become entrenched.
entrenched.
The shadow is everything within us,
feelings, emotions, memories, and
instincts that the conscious mind cannot
tolerate due to early life experiences
and is therefore repressed. It includes
unprocessed grief, rage, anger, uh
terror, hopelessness, shame, and
feelings of unworthiness. And in chronic
illness at the stage these later stages
more advanced three and four
stages these disowned emotional energies
are often expressed
sematically. The body carries and
expresses and speaks what the psyche
cannot or as Bessel Vanderulk says the
body keeps the score. And this is not to
say our illness is psychosmatic in in a
dismissive sense, but rather that
emotional repression and physical and
the consequent physical dysregulation
are inextricably
linked. Jung Yung famously wrote and
everyone would know this quote that
until you make the unconscious
conscious, it will direct your your life
and you will will call it fate. And in
the context of chronic illness, this
means that unless deep emotional and
unconscious drivers of illness are
safely without
digging are identified and gradually
brought to awareness
consciousness where they can be
completed. It's not going to happen
basically otherwise the nervous system
will remain primed for ongoing distress.
We need to switch it off by completing
the natural cycle of
activation and deactivation. Which is
why at the advanced stages, healing
requires more than cognitive processing.
It demands a whole system approach that
honors both the body's protective
patterns and the emotional truths that
Steven Pes developed polyagal theory and
he provides a you know a very powerful
framework for understanding why healing
requires more than simply thinking
differently or retraining the brain in
isolation. According to pores, the
autonomic nervous system is
hierarchically organized into three
states. Got your vententral veagal,
safety, connection. And this is where we
feel safe, seen, calm, and
connected. Not just to others, but
ourselves and our environment, other you
know, everything. We are just operating
connected to all that we experience in
safety, feeling seen, feeling ourselves.
And the vententral veagal system allows
for optimal function, digestion, repair,
immune function, and rest.
rest.
And in sympathetic fight orflight mode,
we'll understand this is when we're
activated vententral veagals, poly
polyvagal states, parasympathetic mode.
In the sympathetic fight orflight state
threat, this sympathetic nervous system
activation occurs and this
mobilizing the body for defense or
escape. And of course, we need this.
This is absolutely fundamental uh if
we're in acute danger.
And you know, it's a survival mechanism.
But if the
danger remains sustained, for example,
in reality, if we are in a dangerous
environment in a relationship that
perhaps threatens us and we can't ever
take our guard down or for the reasons
we've explained before, there are things
going on in the subconscious that we're
not aware of. This becomes the ongoing
situation to be stuck in this situation
of activation. The
The
third system he talks about is dorsal
veagal. This is shut down. This is
freeze and collapse. So this is when
danger is inescapable. We can't fight it
or escape it. And the system may enter a
dorsal veagal shutdown. This is
literally when you're at the point of
death. You you can't do anything but but
freeze or fall. And it's marked by a
numbness. really literally feeling
frozen, profound fatigue, collapse and
dissociation. And this is particularly
prevalent in stages three and four of
chronic illness. The nervous system
often becomes trapped in a combination
of sympathetic overdrive and dorsal
collapse. Which is why many people
experience both high high anxiety, hypervigilance
hypervigilance
um and
arousal, sympathetic nervous system
arousal with profound exhaustion, a loss
of power, numbness, brain fog, which is
the dorsal veagal.
Paul just emphasizes
that healing requires first establishing
cues of safety both externally and
relationally in relation to other people
ourself our environment and internally.
the body mind
this and restoring some level of
vententral veagal tone, deeper work such
as emotional processing, shadow
integration and even physical
rehabilitation may seem impossible, too
much or
unsafe, which very much aligns with the
work of trauma experts such as Bessel
Vanderulk, who states, "The body keeps
the score as I said. So that meaning
that unresolved trauma and threat are
effectively held in the nervous system
and the tissues of the body not just the
mind. These are not just thinking
errors. This is not just a perceived a
perception of danger. It is actually now
wired in to our very physiology.
And I just want to say
despite often the depths of
entrenchment at these later stages, the
most important message remains. The
nervous system is neuroplastic. It is
completely capable of change.
Norman Deutsch's groundbreaking work on
neuroplasticity demonstrates that even
when measurable changes have occurred in
the brain as I talked about before and
the embodied brain your nervous system
such as PFC shrinkage amydala um
hypersensitivity the brain and nervous
system retain their lifelong ability to
rewire and restore
balance Daniel Seagull who's a pioneer
in interpersonal neurology ology
reinforces with this with his oft quoted
where attention goes, neural firing
flows and neural connection
grows. Meaning that through consistent
titrated and relational safe practices,
new neural pathways can be built
supporting regulation
um resilience and healing. However, it
is essential to understand that
neuroplastic change is biological and
organic. It doesn't happen quickly. And
just as entrenchment has happened often
over years, rewiring entrenched patterns
into our
system to heal from it requires time,
repetition, precision guided support,
and patience.
Quick fix approaches do not honor the
depth of the healing journey. For
advanced cases, the brain and the body
must learn new patterns of safety and
trust slowly replacing old pathways of
pain, fear, bracing, and protection to
create new healing pathways. So
interventions must be clearly matched to
the stage of the
illness and this is
clear to me
anyway. So here's a general road map.
The way I see it in stage
one early to moderate complexity of mind
body conditions the nervous system
retains significant flexibility. Brain
retraining methods such as PRT, EAT, SOS
approach and CBT etc are highly
effective because the maladaptive
patterns are relatively recent and less
entrenched. The prefrontal cortex can
still readily override misfiring danger
signals with messages of safety and just
allowing these things to be there and
quite indifferent to them. and emotional
awareness and expression exercises can
recalibrate responses quite quickly. So
the goal to restore confidence and you
know is confidence and to break feedback
loops and re-engage with life. All good.
Excellent. But for stage three for more
complex multi-system illness where the
nervous system is showing deep patterning
patterning
and you know habituated loops these
these standard retrain retrainings may
offer you know partial relief but often
fail to sustain progress as I said so we
must add additional support trauma
informed therapy and don't freak out
because it's not as bad as you think
people it's not like you have to go go
and dig up your past and and and and
rekindle the horrors of yester years. It
it really can be much more simple and it
truly is the way to resolve these
issues. So, trauma-informed
therapy, internal family system work,
sematic experiencing, things like things
like focusing um emotional work and
polyagal theory to support the system.
And then once that has been established,
some shadow work safely exploring the
repressed emotions without overwhelming
the system
allowing what the body wants to do to be
supported and let it let it do its
thing. We don't have to go and seek
these things. If we create enough
capacity and safety in the system and
enough ability to allow and be with
incredibly difficult
sensations, this is key. So this will
establish a relational
safety with not only ourselves even a
little bit to be with a difficult
sensation, a difficult feeling, but also
it's about establishing safety with
other people and and perhaps a
practitioner who will guide you and
support you and witness you through what
is so difficult and what you've been
suffering with so long. And it has to be
with someone who understands deep trauma
and mind body
dynamics. Has to be someone who's either
understands it in the way I'm talking
about or has been through it themselves
to the point that they have understood
its anatomy from within.
Thus, the
goal is to is to unwind these
deep-seated protective patterns whilst
reinforcing bodily safety with
correlation to others. Feeling okay with
the body, the environment of our own
body and who we are, becoming ourselves,
being okay with our our true feelings, our
our
environment, the new authentic way we
might have to behave in order to listen
to those
voices. At stage
four, where we've seen severe collapse
and multi-system dysfunction, the
nervous system is often profoundly shut
down or hypersensitized.
hypersensitized.
And any emotional work, emotional
excavation would would be would be too
much. So really the only emotional work
you would do is is that of allowing what
arises and to really really strengthen
this ability to be okay with what the
body is sending you.
And if we did anything more than that
too much, there's too much digging um
that that's contraindicated until a
foundational safety to be with what is
arising uh is is is established and
trust in our ability to be with it.
Trust in the body is established.
So the appropriate focus of
co-regulation and attunement is really
really important and gentle relational
work that emphasizes safety above all
and then to from there micro titrate
within a graded schedule of activities,
graded schedule of exposure is
absolutely vital. Really really
consistent work has to be done to these
sensations, the emotions and to to
sematically experience them in tiny
consistent doses through tracking,
focusing, mindfulness and
allowing and also to work to build the
ego selfrust. Starting to be okay with
who we truly are. believing that we have
to be a certain way to be safe and
starting to gently have trust in the
fact that we can say no when we want to,
that we can feel our emotions if they
arise, that we are the person we really
are rather than who we had to be.
And this in time will help to convince
our our
suspicious minds, the egos, uh to be
more patient and have faith in the
body's wisdom. We don't have to then
think our way out of it and understand
it. We can start to trust these
protocols that we detail here.
And within that is is really learning,
as I said, a sort of boundary setting pacing,
pacing,
establishing a a a strong framework of
consistent activity, exposure to to
actions, thoughts, emotions, everything
in a way that learns how to be with
ourselves again, but to within a
boundary that honors the body and the
self, who we truly are, you know, our the
the
limits. Um, so we avoid the pushing and
crashing, striving and achieving to get
well. Now the goal is to restore
foundational nervous system safety so
that we can prepare the ground for
deeper healing over time which is added
as stabil stability and our ability to
allow and trust starts to acrewue.
So as I said even the most entrenched
cases where the brain has undergone
measurable changes and the body has
settled into patterns of fatigue, pain,
hypersensitivity are always open to
healing. Always. As Norman Dodge and
Daniel Se se Seagull have shown,
neuroplasticity continues throughout our
life. And with the right kind of
support, relational safety, titration,
and deep respect for the body's pace,
pace,
and developing a strong ability to
allow, the nervous system can learn to
trust again, unwind, restore balance,
and naturally reeregulate. We can
realign with ourselves and our bodies
from a place of genuine coherence and
balance, not
forcing. As Jung reminds us, the
privilege of a lifetime is to become who
you truly
are. And for many on this journey,
healing is not about symptom relief,
mere symptom relief. It's a profound
process of
becoming whole again, of reclaiming lost
parts of self and stepping into authentic
authentic
vitality. And I believe this is the
standard of care we must now build
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