The Driver

Even single-celled organisms have threat detection built in. If you put a single bacterium in a dish with poison on one side and food on the other, it will move toward the food and away from the poison. Which makes sense when you realize that aside from reproduction, the ability to avoid threat is the most important survival function any living being has. It is so vital that something very close to our human threat detection system exists in the lamprey, a jawless fish that's been around for 500 million years. The pressure to get it right was so intense that evolution perfected it almost immediately, and it has remained largely unchanged since. To put 500 million years into perspective, the first dinosaurs appeared 230 million years ago and went extinct 66 million years ago. This fish predates them by almost 300 million years.

The lamprey's brain is so primitive it barely looks like a brain at all; it looks more like a swollen nerve cord. But when researchers examined this ancient blob of neural tissue, seemingly so different from modern animals, they found the same threat detection architecture that we see in modern humans today. An amygdala-like structure for detecting danger, a periaqueductal gray (PAG) for coordinating response, and a hypothalamus for triggering stress chemistry. This basic setup appears in every vertebrate, and has for half a billion years. And what we see in our world today are the winners of this long evolutionary march toward the present. Anyone whose threat detection system wasn't quite up to snuff? They're not our ancestors, or anyone's ancestors. Their genes got edited out of the evolutionary line.

Half a billion years is a long time not to get an upgrade. Evolution tinkers constantly - unless something is working so well there's nothing to improve. So let's look at how this system actually works, and why evolution never found a reason to change it.

This brain system's whole job is to keep us alive by evading threats, and it does so in a one-two-three punch that happens in the blink of an eye. Which makes evolutionary sense, because the animals who could respond the fastest were the ones that got to live. It really is as simple as that. Part one of this sequence happens in the amygdala, whose job it is to process your surroundings and decide what’s a threat. It has two main ways of doing this: the high road, which involves conscious thought and that we will get into more later, and the low road, which is more relevant for this evolutionary snapshot we’re painting right now. The way the low road works is that sensory information, what you see, hear, smell etc., gets sent directly to the amygdala before your conscious mind even knows it's there. This takes about 12 milliseconds. The amygdala gets a rough, blurry sketch of what's happening - something big moving fast, a loud sudden noise, a shape that pattern-matches to "predator" - and it fires. You jump before you know what scared you. You flinch before you've decided to flinch. The whole point is speed over accuracy, because for 500 million years, the cost of reacting to a false alarm was low, and the cost of reacting too slowly was death.

And because overreacting is evolutionarily better than underreacting, the amygdala is primed to overattribute things that are similar to threats as threats. Remember the woman from the last chapter who had a full asthma attack upon seeing a paper rose? Her amygdala had learned "rose = danger" so thoroughly that the visual pattern alone triggered the entire cascade. No conscious thought required, no time to say "wait, that's paper." By the time the high road could have evaluated the situation, her body was already reacting. This is what’s happening with ever-expanding lists of food sensitivities, or allergies. And this is the system at play in many of the diseases we know about.

Part two of the threat response is the job of the periaqueductal gray, otherwise known as the PAG, which coordinates the body’s actual response. The PAG has two primary modes of response, which you can think of almost like a toggle switch. The brain quickly asks the simple question: will action improve this situation? If the answer is yes, if there's somewhere to run, something to fight, some action that might work, the dorsolateral part of the PAG activates, which we’ll call the mobilizing PAG. Your heart rate spikes, your energy stores are mobilized, and your muscles prepare for action. This is fight or flight, the one everyone's heard of.

But if the answer is no, like if you're trapped, or if the threat is too big, or if there's just nothing you can do, a different part activates. The ventrolateral PAG triggers freeze, shutdown, and/or collapse, which we’ll call the immobilizing PAG. Your heart rate drops, your body starts trying to conserve energy, and in extreme cases, you can dissociate, or go numb. The classic example is prey animals playing dead when caught by a predator - that's the one most people have heard of. But the freeze response isn't just for "a predator has you in its jaws." Sometimes the answer is "not right now, but maybe later." An animal that detects a predator but hasn't been seen yet holds perfectly still. The bet is: stay frozen, and maybe when the threat passes, I can escape. Sometimes the answer is "no, and fighting would make it worse." When a lower-ranking animal encounters a dominant one, it shows submission and withdrawal rather than fighting a battle it would lose. Better to back down than get torn apart. The system is conserving resources for situations where action might actually help.

Sometimes the answer is just "no." When an animal is sick or injured, it hunkers down and waits. Or when an animal is subjected to inescapable stress - stress where nothing it does changes the outcome - it eventually stops trying at all. Researchers documented this with dogs given inescapable shocks. The dogs would struggle at first, trying everything to escape. But after enough exposure to "nothing works," they'd just... stop. Even when escape became possible later, they wouldn't take it. The system had learned: action doesn't help here. Stop wasting energy on it. Even fish do this.

And people have been noticing these two opposite patterns and trying to explain them for decades. Attachment theory identified "anxious attachment" and "avoidant attachment" - which map perfectly onto people whose PAG tends to flip one way versus the other more often. They attributed it to how we were parented, but what they actually did to figure those out was test young children in situations where they felt there was something they could do to restore connection with their caregiver, and situations when that connection seemed impossible to restore. They were literally testing what happens in children when the two PAG responses were activated. Polyvagal theory talks about "dorsal vagal shutdown" and "sympathetic activation" which are again, these two responses playing out. It’s not the vagus nerve causing those responses; the vagus nerve is ultimately just a biological wire, no one is out there walking around with a floppy vagus nerve. But what Porges was witnessing when he came up with his theory was this very clear PAG switch pattern. And while these frameworks got the underlying mechanisms wrong, it makes sense that people kept trying to explain what they were seeing. These patterns are obvious if you watch human behavior. Or really any animal's behavior. Because this toggle between "I can act" and "I can't act" is the oldest decision in the animal playbook.

Part three is the job of the hypothalamus, which you can think of as the pharmacy of the brain. Within seconds, your hypothalamus releases the entire biochemical cascade that shifts your body from homeostasis to survival mode. Your heart rate changes, your blood flow redirects, digestion shuts down, glucose mobilizes. Everything about your body's chemistry reorganizes around one goal: survive this.

And for 500 million years, this system worked perfectly. A threat would appear, the amygdala would detect it, the PAG would coordinate the response, and the hypothalamus would deploy the chemistry to fuel it. The animal would fight, flee, or freeze, and then the threat would pass. And once this happened, the system would reset. The chemistry flooding the body would start to clear, heart rate would return to baseline, digestion would turn back on, and the animal would go back to living normally. The stress response was designed to last minutes, maybe hours in extreme cases, and then it was over. And this is still how it works, in every animal on the planet. The ancient system activates when needed and deactivates when the threat resolves.

Except in one species.

Because around 100,000 years ago, a different switch got flipped. For hundreds of thousands of years, anatomically modern humans existed with brains very similar to ours. They made the same basic stone tools, generation after generation. They lived in small groups, and left little trace of symbolic thought.

Then suddenly, the archaeological record explodes with evidence of radical behavioral change. Cave paintings appear depicting animals, humans, and abstract symbols. People start wearing jewelry made from shells and bones, some transported hundreds of miles from their origin. Burial sites begin including grave goods like tools, ornaments, and food, suggesting belief in an afterlife or at least symbolic thinking about death. Musical instruments appear, complex multi-part tools, the creation of which required planning several steps ahead, trade networks spanning continents, and boats capable of reaching Australia across open ocean.

This wasn't evolution in the way Darwin understood it, with gradual changes over millions of years. Harari in Sapiens described this as an almost overnight phenomenon around 70,000 years ago. But the skull record seems to tell a slightly different story - brain size had already reached modern levels by 300,000 years ago, but brain shape continued evolving, with the frontal and parietal regions expanding into their modern globular form between about 100,000 and 35,000 years ago. But whether you call it practically overnight like Harari claims, or something that happened over the course of 65,000 years, both are lightning fast for something this advanced to come online.

And it makes sense evolutionarily why this trait got selected for so quickly. Recursive language alone - our ability to nest ideas within ideas indefinitely, to say not just "danger" but "the man who saw the lion that killed the hunter from the neighboring tribe is afraid to go near the watering hole where it happened" - was an immediate survival advantage. The populations with this capability rapidly outcompeted and replaced those without it.

The mismatch

But because this adaptation happened so fast, there wasn't time for evolution to integrate these new cognitive abilities with the ancient survival systems. A hundred thousand years is nothing in evolutionary time. These kinds of huge biological adaptations typically take a million or more years to develop and refine. We developed it in less than 10% of that time. And it’s only been another 30 thousand or so years since. This is a really new evolutionary ability that came online practically overnight, and we haven’t had time to adapt.

We have the ability to imagine infinite futures, to create complex social hierarchies, to contemplate our own mortality, to compare ourselves to hundreds of others, and we keep running all of it through threat detection systems that are still shockingly similar to that of the lamprey. And this mismatch is the core problem. We can now maintain threat activation through thought alone, like the rumination researchers were showing, which is something no other animal can do.

Remember we said the amygdala has two pathways - the low road that reacts in 12 milliseconds, and the high road that involves conscious thought. The low road kept us alive for 500 million years. But the high road? That's what the cognitive revolution gave us. The ability to generate threats through thought itself. To remember past dangers, imagine future ones, replay social rejections, and worry about scenarios that haven't even happened.

The lamprey doesn't have a high road. It can't think about the predator that attacked it last week. It can't worry about whether there might be a predator around the next rock. It detects threat, responds, the threat passes, and its system resets. But humans? The high road can feed thoughts into the low road, and the low road reacts to those thoughts exactly as it would to a real predator. The amygdala fires, the PAG coordinates, the hypothalamus floods the system. We're triggering the ancient hardware with our thoughts, and it responds the same way it has for 500 million years.

And as we saw in the last chapter, when that threat activation can be kept on by thought alone, with pathostatic chemicals staying chronically activated, it physically remodels the brain. The hippocampus shrinks - the structure that would normally contextualize memories as 'past' rather than 'present danger.' The prefrontal cortex thins - the structure that could regulate the amygdala and say 'that's just a thought, not a real threat.' Meanwhile the amygdala grows larger and more hyperconnected, generating more threat-related thoughts. The very structures that could turn the system OFF are being degraded by the process they're supposed to regulate. The high road that should help us think our way out of danger instead keeps us trapped in it. Our modern thinking brains never got the chance to evolve to interface effectively with the animal threat detection system, and that mismatch gave us the mechanism to get mentally stuck. And, subsequently, sick.

This is the human condition. This feedback loop of our thoughts alone triggering our ancient threat system, and then pathostasis remodeling the brain to generate still more threatening thoughts, is why we suffer in ways that animals do not. A zebra runs from a lion, escapes, and goes back to grazing. It doesn't lie awake replaying the attack, doesn't develop a generalized fear of open plains, doesn't ruminate about whether it will happen again. The threat passes and the system resets. But humans? We can suffer for decades from things that happened once, from things that might never happen, from purely imagined scenarios our thinking brains generate and our ancient hardware can't distinguish from real danger.

We can see this in reverse when animals are exposed to us. Dogs co-evolved specifically to attune to human nervous systems, and researchers have found their long-term cortisol levels synchronize with their owners' cortisol levels. The owner's personality predicts the dog's stress hormones. Cats in the same households, less selected for human emotional attunement, show no such synchronization. And the disease rates bear this out: dogs get cancer at almost double the rate of cats. Zoo animals, trapped in inescapable confinement, whose immobilizing PAG gets stuck on, develop chronic diseases at rates far exceeding wild populations. Almost one in two captive wolves die of cancer while wild wolves almost never do. The threat system works fine when threats resolve. It's the chronicity that breaks it - and we're the first species with the ability to maintain chronic threat, either internally through thoughts, or externally through modern life circumstances.

The introduction of therapy

And this suffering was always just accepted as part of our human existence, until Freud came along. In Vienna in the 1890s, a neurologist named Sigmund Freud was trying to understand why some of his patients couldn't move their limbs despite having no physical injury, or why past experiences seemed to control present behavior in ways people couldn't explain or stop.

He started noticing things like a woman whose father died when she was twelve who would, twenty years later, still react to authority figures as if they might abandon her at any moment. A man who'd been humiliated in school would avoid situations as an adult where he might be judged, his body responding with a racing heart and shallow breathing as if the childhood classroom threat were happening now. Freud also noticed that talking about these experiences, bringing them into conscious awareness, sometimes helped. Not always, but often enough that he built an entire practice around it. He called these stuck patterns "repressions," believed they were buried in the "unconscious," and theorized that making them conscious through psychoanalysis would resolve the symptoms. What he was actually seeing was the threat circuit getting activated by cues in the present that matched patterns from the past, and the amygdala firing because something in the current situation pattern-matched to a previous threat, triggering the whole cascade even though the original danger was long gone.

So Freud built an elaborate explanatory model to explain what he was observing. The Oedipus complex, penis envy, id, ego, and superego battling for control, defense mechanisms, and psychosexual stages. In the absence of any established way to make sense of this, he created his own elaborate explanations to explain what he was observing, metaphors dressed up as mechanisms. And because Freud was brilliant and persuasive, and because his observations about people getting stuck in past patterns were genuinely accurate, his model became the foundation of psychology for half a century.

By the 1950s, a generation of researchers had been trained in Freudian theory, and many of them were starting to notice it didn't actually work very well. Psychoanalysis required years of expensive treatment, produced inconsistent results, and couldn't be tested scientifically because every failure could be explained away as resistance or insufficient analysis. It had become unfalsifiable—if you got better, psychoanalysis worked; if you didn't get better, you weren't ready to get better yet.

So in reaction to this unfalsifiable and not very effective framework, behaviorism came along. B.F. Skinner, Joseph Wolpe, and others said: forget the unconscious, forget Freud's model, forget everything that can't be directly observed and measured. Behavior is what matters and symptoms are learned responses to stimuli. Change the stimulus-response pattern and you change the behavior. And they were able to prove it too. Wolpe could take someone with a snake phobia and, through systematic desensitization, gradually exposing them to snake-related stimuli while they remained calm, eliminate the phobia in weeks instead of years. Skinner showed that you could shape behavior through reinforcement schedules, and that consequences determined what behaviors persisted.

The behaviorists were right that Freud's elaborate method was wrong. They were right that you could change emotional responses through learning. They were right that observable behavior mattered more than untestable theories about unconscious drives. But in their eagerness to reject Freud's unfalsifiable explanations, they threw out the baby with the bathwater and started a movement where thoughts and feelings got removed entirely from the field. Only what could be externally observed and measured, stimulus in, response out, counted as real.

What both sides were actually documenting was the same phenomenon from different angles. Freud had noticed that past experiences created patterns that activated automatically in the present. The behaviorists had discovered that you could change those automatic responses through repeated pairing of the trigger with a different outcome. But because they were fighting over whose explanation was correct rather than examining what they both observed, neither side recognized what they'd found: our ancient learning system that could be updated through experience, but only under specific conditions. Instead, psychology fractured into warring camps, each building elaborate theories to defend their approach, each certain the other side was fundamentally wrong about human nature.

By the 1960s, both approaches dominated different corners of psychology, with psychoanalysis mostly in universities and private practice, and behaviorism mostly in research labs and institutional settings. And this is when Aaron Beck, who had been trained as a psychoanalyst, was running experiments trying to validate Freud's theory that depression came from "anger turned inward." He was using dream analysis to look for evidence of this repressed hostility. But what he kept finding instead was that his depressed patients had consistent patterns of negative thoughts about themselves, their experiences, and their future. The same patient who seemed fine discussing neutral topics would, when talking about their lives, automatically interpret everything through a lens of failure, inadequacy, and hopelessness. "I got a B on that test" became "I'm stupid." "My friend didn't call back" became "Nobody likes me." "This therapy session went well" became "I'm just fooling you, eventually you'll see I'm hopeless too."

Beck started calling these "automatic negative thoughts" and documented how they preceded emotional shifts. A patient would be talking normally, then one of these thoughts would flash through their mind, often so quickly they barely noticed it, and suddenly their mood would drop, their posture would slump, and even their voice would change. It was as if the thought had triggered something physical. Which, of course, it had. What Beck was observing was the high road feeding the low road, thoughts activating the amygdala, triggering the threat cascade. But Beck didn't have that framework. What he concluded was that these distorted thoughts were causing the depression.

This became the foundation of Cognitive Behavioral Therapy (CBT). Beck identified common patterns of "cognitive distortions" like all-or-nothing thinking, overgeneralization, and catastrophizing. (Which if you look at this list, it’s exactly what your brain should be doing when it’s making quick real time threat assessments. That isn’t the time for nuanced thinking, it’s a time to make a quick decision so you can act. These are adaptive thought patterns when you’re in threat mode.) He then developed techniques to help patients identify and challenge these distorted thoughts. So for example if you notice yourself thinking "I'm a complete failure," you examine the evidence. Is that actually true? What evidence contradicts it? What would you tell a friend who said this about themselves? The idea was: fix the distorted thinking, and the emotions will follow.

This seems like it should work based on what we just established, right? Our ability to think threatening thoughts activates our pathostatic chemistry, so thinking different thoughts should turn it off. We'll go into this more in the next chapter, but the problem is that these aren't conclusions someone reasoned their way into. They're conditioned associations that got wired into the threat circuit through repetition. Think about the woman who had an asthma attack from a paper rose as an example. Her brain had learned 'rose = danger' so thoroughly that the visual pattern alone triggered the cascade. The same thing happens with thoughts. When the threat circuit fires repeatedly at the same time you're thinking "nobody loves me" or "I'm a failure," those thoughts become part of the trigger pattern itself. Now the circuit triggers the thought, and the thought triggers the circuit. They're wired together, bidirectionally, reinforcing each other. You can't reason with a conditioned response. You can't talk yourself out of a threat loop that was learned through experience.

But medicine loves CBT, because it can be turned into standardized protocols that can be taught systematically and delivered consistently. It is short-term, typically delivered over 12-16 weeks, which when compared to psychoanalysis that took years, insurance companies were more than willing to pay for. And they figured out how to make it measurable in a way other therapies had lacked, which meant it produced research papers. Lots of them. Randomized controlled trials showing CBT reduced symptoms of depression, anxiety, PTSD, eating disorders, insomnia, and chronic pain.

But CBT works when it works not because you’ve reasoned your way into better thinking, but because by stopping the thought you’re stopping the threat pattern from firing, you’re interrupting the pattern. But because you’re just interrupting it, you aren’t wiring in a new pattern or changing the old one, typically the benefits are short lived.

By the 1990s, CBT had become the "gold standard" of evidence-based therapy. Insurance companies preferentially covered it, training programs prioritized it and grant funding flowed to it, and it had thus also become something of a weapon. Other therapeutic approaches, like psychodynamic therapy, somatic therapy, and anything else that couldn't be easily manualized and measured, were dismissed as "not evidence-based." Never mind that meta-analyses were already showing all therapies worked about equally well when compared fairly.

The irony is that what Beck had noticed was true; thoughts and emotions ARE connected. The high road does feed the low road. But by concluding that distorted thoughts caused the problem and could be logicked away, it convinced a generation of therapists and patients that if you just learned to think more rationally, you could think your way out of suffering, and if you couldn't, then you probably weren’t trying hard enough.

But people started to notice that this approach wasn't helping as much as the research papers suggested. Lots of patients were getting sicker, getting more stuck, and CBT wasn't helping the way everyone was saying it should. So some therapists started to wonder: what if there was something going on in the body that talk therapy was missing entirely?

Trauma therapy is born

A psychiatrist named Bessel van der Kolk started documenting what he was seeing in his trauma patients. They would come in with histories of childhood abuse, combat exposure, assault, or loss, and trying to think their way out of their symptoms wasn’t working. They could challenge their thoughts all day long, "You're safe now, that was in the past, your reaction isn't logical", and it made no difference, their bodies were still reacting as if the threat were present. And Van der Kolk noticed these weren't just presenting as memories, they appeared to be full physiological states that got activated by present-moment cues. A combat veteran would hear a car backfire and his entire nervous system would shift before his conscious mind had time to register "that's not gunfire." A woman who'd been assaulted would feel a hand on her shoulder in a crowded room and her body would freeze, shut down, go numb, exactly as it had during the original attack. The past wasn't acting like the past in these people’s brains, it seemed more like it was encoded in the body, ready to replay at any moment.

What van der Kolk was observing was exactly what we've been tracking: that threat circuit learning happens through experience and then fires automatically when similar patterns appear. The combat veteran's amygdala had learned "loud bang = mortal danger" so thoroughly that the sound pattern alone triggered the full cascade. The assault survivor's nervous system had learned "can't escape = freeze" and now activated that same immobilizing PAG response whenever anything pattern-matched to similar helplessness. These were conditioned threat responses, the same mechanism that gave the asthma patient a reaction to a paper rose, just playing out across different systems.

But van der Kolk and others didn't have that framework. What they concluded was that trauma was somehow "stored" in the body, that it needed to be "released" or "processed" or "integrated." Peter Levine developed Somatic Experiencing based on watching animals shake off their threat activation, theorizing that humans needed to "discharge trapped survival energy." Pat Ogden created Sensorimotor Psychotherapy to help people "complete" defensive responses that had been interrupted. Richard Schwartz's Internal Family Systems talked about "exiled parts" carrying childhood wounds that needed to be "unburdened."

These frameworks all think of trauma as something fundamentally "other." Something foreign living inside you that needs to be extracted, released, or healed. IFS talks about parts as if they're separate children living inside you with their own personalities and needs. Levine talks about trapped energy as if there's a reservoir of unexpressed tiger-fleeing that's been sitting in your tissues for decades. But there's no trapped energy. There are no inner children. There's no unprocessed material waiting to be integrated. These were very helpful metaphors for what we were noticing and it makes sense why we thought these things for so long. Medicine was completely ignoring the very real patterns therapy was seeing, and these explanations gave people a framework with which to address this ignored part of our human experience. And it helped a lot of people. But because we were missing the core truth, we were still dancing at the edges of what was possible.

Because when it comes down to it, all of those things we were seeing were just your threat system, doing exactly what it learned to do. Firing the same patterns when similarly triggered that it's been firing since the original event taught it "this is dangerous." The combat veteran hearing a car backfire isn't experiencing "stored trauma" - his amygdala learned "loud bang = mortal danger" and so when it hears the loud bang it fires off the threat response in an effort to keep him safe. The assault survivor who freezes when touched isn't holding "trapped survival energy" - her immobilizing PAG learned "can't escape = freeze" and it activates whenever anything pattern-matches to that original helplessness. There's nothing to release, nothing to integrate, no inner child to rescue. There's just learned patterns, encoded through the same neuroplasticity that taught you to ride a bike. Except these patterns are keeping you sick.

And from these explanations came a framework that would dominate trauma therapy for decades. In 1992, psychiatrist Judith Herman published "Trauma and Recovery," which established what became the standard trauma therapy approach: a three-stage model where establishing safety had to come first, before any trauma processing could begin. Herman wrote that 'the first task of recovery is to establish the survivor's safety - this task takes precedence over all others, for no other therapeutic work can possibly succeed if safety has not been adequately secured.' And what started as a reasonable observation, that people need to feel safe in therapy, calcified into a rigid protocol. Trauma was framed as so powerful, so dangerous, that you needed months or years of careful preparation before you could even approach it. That feeling the feelings associated with trauma would 'retraumatize' you, potentially making you worse. That there were 'resources' and 'stabilization techniques' you needed to master first. That certain traumas were 'too big' to work with directly. That your nervous system was so fragile it could be overwhelmed by activation.

This became the dominant framework in trauma therapy. Patients would spend months, sometimes years, in preparation phases. Learning grounding techniques, building their "window of tolerance," identifying their "resources," maybe occasionally "titrating" small amounts of trauma material if the therapist deemed them ready. The actual trauma? That stayed locked away, too dangerous to touch directly, while therapist and patient tiptoed around it with elaborate safety protocols.

But if we look at this through the lens of how we now know the threat activation system works, we can see that this elaborate story around our own feelings having the potential to cause real harm to us, this actually creates the perfect conditions for a never ending feedback loop. Your threat system gets activated, which is something that happens to every animal, every day, as a normal part of navigating life, but now you've been taught to be afraid of that activation itself, which signals more danger to your amygdala, and on and on it goes. That activation of the threat circuit, which is the very thing that needs to happen for the pattern to update, is itself now a threat. Now you're not just afraid of the original trigger, you're afraid of being afraid. You're afraid of your racing heart, your shallow breathing, the physical sensations of activation. The trauma therapy has added a new layer of threat on top of the original pattern.

In a 2024 survey of 348 clinicians, therapists reported high levels of fear about retraumatizing their patients. But they didn’t collectively agree on what being “retraumatized” even means. And therapists who believed they'd witnessed it became significantly more fearful of it happening again, suggesting the fear itself might be shaping what they see. The concept of retraumatization exists because therapists believe it can happen; retraumatization, when it occurs, isn't caused by activation—it's caused by the belief that activation is dangerous. That belief adds a new threat loop on top of the old one. The framework creates the very harm it claims to prevent. If we look at what ‘retraumatization’ actually is, it's…activating the threat circuit. That’s it. Which you need to do in order to update it. The paper rose woman had a full asthma attack from a visual cue. That activation wasn't "re-asthmaing" her. It was her learned pattern expressing itself, and if you wanted to change that pattern, you'd need to activate it under conditions where the feared and expected outcome (can't breathe, going to die) doesn't occur. The activation is necessary, and it’s not dangerous. It's literally the mechanism through which learning happens.

The irony is that some trauma therapy approaches, the ones that show the best results, actually involve activating the circuit. EMDR has you think about the traumatic memory while doing bilateral eye movements, which means you're activating the threat circuit while keeping the prefrontal cortex online, creating the dual activation needed for memory reconsolidation. Prolonged exposure therapy has you repeatedly revisit the trauma memory in detail until the activation decreases, to show your system that the expected catastrophe doesn't occur. Even the somatic approaches, when they work, work because they have you feel the body sensations associated with threat activation while you're actually safe, allowing the pattern to update.

But because these approaches wrapped their techniques in protective stories, "we're carefully titrating exposure," "we're processing the trauma," "we're completing the defensive response", patients have inadvertently learned to be afraid of their own nervous systems, practicing elaborate grounding techniques to avoid activation, spending years preparing for work they were actually ready to do on day one.

The trauma therapy field was seeing something true: these patterns do live in the body - but not the way they think. When therapists talk about 'trauma stored in the body,' they're observing that gut dysfunction, chronic muscle tension, autonomic dysregulation, etc. all happen alongside emotional distress. But these aren't memories held in your intestines or your tissues; they're learned patterns in your brain, specifically in the threat detection circuits we've been tracking, that then reprogram your entire physiology. Your gut's enteric nervous system gets reprogrammed to be hyperexcitable when you stay in pathostasis for extended periods of time, and then unless it gets updated by the brain, it stays that way, sending constant danger signals back up to your brain. Your muscles learn to hold tension. Your immune system learns to stay activated. But the learning, the actual programming? That's all happening in your brain.

These and other fields of psychology were doing ground breaking work with the information they had available to them at the time. They were seeing something that medicine couldn’t: that this was happening not just in our 'thoughts', as though those were just floating in the ether, but in our brains and subsequently, our bodies. The problem was that without the complete understanding, each one of these competing modalities had just one or two pieces of the whole that was needed to work with these problems effectively. And because they each only had a fraction of the whole, when you look at them objectively, strip away the bias and look at the actual data about efficacy? What shows up again and again is this: They all worked about equally well.

The "Dodo Bird Verdict," named after the scene in Alice in Wonderland where the Dodo declares "everyone has won and all must have prizes," has been replicated in meta-analysis after meta-analysis. When you control for researcher bias and actually compare therapies head-to-head: cognitive approaches, somatic approaches, psychodynamic approaches, behavioral approaches, acceptance-based approaches, they all show roughly equivalent outcomes. Not identical, but close enough that the differences are clinically meaningless.

This finding has baffled the field for decades. How could approaches with completely different theories, completely different techniques, completely different explanations for what's wrong and how to fix it, all produce the same results? The answer is obvious once you understand pathostasis. Every one of these approaches, regardless of its stated theory, occasionally creates conditions where the threat circuit can update. They are being present with the activation in a way that not only doesn’t make it worse, but in fact shows the amygdala, ‘it’s all good, this isn’t actually a threat.’ They're all doing the same thing through different doors: activating the learned threat pattern in the presence of enough safety that the circuit can learn to stand down.

And in addition to the tools of each modality, they are all also helping partially due to the process of therapy and the therapeutic relationship operating similarly to how placebo operates. Having hope, and feeling like someone is going to help, these work because they directly counter the threat state. Social connection calms the nervous system, we even see this in the fish who’ve been using this threat system for 500 million years. Feeling understood signals safety to the amygdala.

The Dodo Bird Verdict is just the data telling us, over and over, that all of these approaches are accessing the same underlying mechanism, the threat detection system that we've been tracking through this entire chapter, and that they each found a piece of it. They each built elaborate theories to explain their piece. And they've spent decades fighting over whose piece was the real one, whose explanation was correct, whose approach deserved the funding and the prestige.

So the reason humans can create and maintain pathostatic conditions is because we evolved our cognitive abilities way too fast for them to integrate effectively with the 500 million year old threat detection system we share with all vertebrates. Let’s look at what the learning and behavioral research tells us about how this happens mechanistically.