Mechanism for Change

Imagine a bowl sitting on a table with a marble inside. No matter where you drop the marble on the inside of the bowl—high up on the rim, halfway down, wherever—it will always roll down and settle at the bottom. The bottom of the bowl is what scientists call an attractor state: where systems naturally settle and stay. Push the marble and it'll roll up the side a bit, but then it comes right back down. This is the key feature of an attractor: the system tends to return to it even after being disturbed. The 'basin of attraction' is the entire inside surface of the bowl, all the places the marble could start from and still end up at that same stable point.

This started as a mathematical concept, formalized in the 1960s for describing how dynamic systems behave, and was popularized by John Hopfield in 1982 when he showed our human neural networks work this way too, for which he won a Nobel Prize in 2024. Since the 80s when it was discovered, researchers have been finding attractor dynamics everywhere in biology, in things like cells, immune responses, and brain states. In 2022, a team at the Kavli Institute in Norway captured this happening in real time; using electrodes they could actually watch the brain settle into stable patterns exactly the way the math predicted.

A small-scale attractor state that most people have probably seen in their own lives is that it’s easier to maintain our weight than to change it. Once we sit at a certain weight for a while, the body treats that as its set point and resists changing it; the marble of that system wants to roll to the bottom of the bowl, maintaining its homeostasis.

This same dynamic plays out at the level of whole-body health. Any given system can have multiple stable states, and which one you end up in at any given moment depends on context, (like with the context based memories) and your reaction to the context. Remember when we talked about how people often feel better on vacation, and then snap back to illness the minute they return home? That’s an example of this in action. You have a healthy attractor state, a stable, maintainable healthy state that can get activated when you get out of the context of your disease. And then another attractor state that contains your disease expression, one with multiple entry points that pull you back in when you return to your normal life. And this is why healing can feel so hard. Why medicine thinks it’s incurable. Because we can never get rid of these attractor states, they are right about that piece. We learned that our brain's wiring works by adding new things, not replacing old things. So if you’ve been cancer free for 5 years and your spouse dies, it’s possible, without conscious awareness, that you fall into that old basin and your cancer returns. Or you haven’t had IBS in years, but something pulls you back in and all of a sudden it’s like your entire symptom symphony has shown back up and started playing the slow march to decline your body knows so well.

And because we haven’t known what this was, we have seen this as “relapse”. It feels helpless and hopeless and crushing. And with what we know about the PAG states, this feeling of helplessness can lead to an immobilization threat response, which then further cements your fate of being stuck in this state. But what is ALSO true is that the healthy bowl you’ve been in for years at that point, that bowl is available too.

And attractor states aren’t a new concept to us at this point, because they are actually exactly what we walked through in chapter 9 when we talked about neuroplasticity. Think about the Merzenich monkeys. When those monkeys spent weeks spinning discs with their fingertips, the cortical map for those fingers expanded dramatically—it literally overtook neighboring territory. The enlarged map becomes the attractor. The neural real estate dedicated to that activity grows so large that signals naturally flow there. Electricity follows the path of least resistance, and the most-used pathways have the lowest resistance. More synapses, more connections, more myelin wrapping those connections. The signal doesn't have to be "pulled" toward the attractor—it falls there because that's where the infrastructure is. And pathostasis is an attractor state; it’s a bowl your system has settled into. So given that, let’s put together everything we’ve uncovered in the research and see how we can build a new competing bowl.

What doesn’t build a new bowl

Medicine says your disease is caused or worsened by poor diet, lack of exercise, inadequate sleep, and too much ‘stress’. Which means the answer becomes lose weight, eat better, sleep more, reduce stress by changing your lifestyle, and your condition will improve. Wellness says something similar. It says you need to optimize your inputs through clean eating, movement, sleep hygiene, stress management, supplements, and routines. So the message on both sides of the aisle seems to be: the problem is your inputs, and the solution is perfecting them.

But our ancestors had terrible inputs by these modern standards we have been optimizing for. They didn’t have modern mattresses or shoes or even consistent shelter. They didn’t have consistent food sources. They had actual predators and tribal warfare and high infant mortality rates. Our ancestors’ stress, the lifestyle kind we blame for our poor health, was very high and persistent. But studies of hunter-gatherers show that they don’t have epidemic levels of chronic diseases like we do. Our bodies are actually robust and able to adapt and tolerate extreme levels of imperfect inputs, they had to be. The animals that could handle the stress and imperfect inputs of our ancestors were the ones that survived to pass on their genes. Which means the difference isn’t the inputs. And if you think about this logically, it just makes sense. If optimizing our macronutrients and exercise and sleep were the solution, don’t you think more people would have actually healed using these methods? Even medicine doesn’t seem to think those things will heal us, or they would have a model for curing chronic illness and not just remission. What medicine seems to think is that we are on a death march to dysfunction and disease, and the only way to stave it off is to optimize everything perfectly.

But what we have discovered as we’ve looked across all the research, is that optimizing inputs, when it does help, helps by pushing you up the sides of the bowl for a bit. But ultimately people end up sliding back down and from the outside it may look like you weren’t trying hard enough, but the reality is that it was a losing battle from the beginning. Because the problem was never the inputs, the problem was being stuck in a pathostatic attractor state.

The way all animals' brains work is that they have a threat detector system that is always on. You can think of it like Alexa or Siri waiting for you to say their name. Our brains are scanning for danger in a similar way, it’s a passive system that is always watching, always listening. For 500 million years, this detection system only activated when an actual threat was present or suspected, and when that happened it would fire off your threat response and ready you for the danger it had perceived. But with the cognitive revolution came the ability for our brains to find threat cues through thoughts alone. Which means that we are always looking for danger and threat, and we can always find it. And the threat system can't tell the difference between a real threat and a thought about a threat, it just responds. So we can fire the full physiological cascade sitting safely on our couch, worrying about something that might never happen or that has already happened.

And even that doesn’t keep pathostatic chemicals on, or every single human would be sick. What actually keeps pathostasis running is when the threat activation itself becomes a threat to our systems. When we feel mobilized or immobilized, activated or shut down, and our wiring or our reactions see that threat state as a threat itself. That’s when it becomes a feedback loop that can keep our pathostatic chemicals on indefinitely.

What the science shows does build a new bowl

We’ve walked through all the learning, behavioral, and neuroscience research, so now let’s put it all together so we can see what it takes to build a new bowl. There are a few key components and taken as a whole it’s actually extremely simple. So simple that it will be tempting to pattern match it to other things that haven’t worked, but stay with me for a second as we walk through this. Based on the science we’ve laid out in the last 3 chapters, let’s summarize the primary pieces we need to both create a new bowl, and augment the threat loop wiring that already exists.

The first is dual activation of the implicit and explicit systems. You need to both feel the physical sensations of activation, either immobilizing or mobilizing, in your system, and allow it without treating it like a threat itself. While also consciously noticing that though this feels like a threat, it’s not actually threatening. Showing your body safety through your thoughts about the activation and your reaction to your physical state.

This has to happen across contexts. You have to experience this safety signaling of both implicit and explicit systems at the same time in all the contexts of your life where they occur. Doing it just in your bedroom or just in your car means that when it happens in your living room or at work, you will still fire off the entire cascade like you always have. It has to be updated everywhere. And intuitively this also means that you need to do it over time. You can’t cram or front load this learning, it needs to become the way that you respond to your system over time. This is a lifelong process.

And just to really drive this point home, in order for these loops to update, you have to be signalling safety, both physically and mentally, every time this activates. And this is not done by suppressing or trying to get rid of it, and this is not done by trying to run away from it or distract. You have to allow the activation to be there and then show your system that it’s not a threat.

Imagine for a minute that you grew up in the jungle and there was always the threat of tigers. Every time you see anything remotely resembling a tiger, your system fires off the whole cascade of chemicals and physiological responses. But now you’ve moved, you live in modern society, and you go to the zoo. When you approach the tiger enclosure and see the tiger, your body will naturally fire off the entire threat loop cascade. The chemicals, the physiological tension and reaction patterns, everything. This kind of response is what we call trauma in our modern world, we talk about the reactions from past experiences being stored in the body. We maybe decide we have a tiger trauma and we lived a hard life and now when we see tigers at the zoo we fire off this response that doesn’t match the current reality, and so this feels wrong and maladaptive and we create a complex narrative around it. But in actuality, our body is just doing what it learned to do. See a tiger, signal danger.

The way we work with this is not to go talk about it in a therapists office, and work through how hard and scary it was to be around tigers our whole lives, and lament that we can’t go to the zoo like a regular mom with our kids. It’s not to try to bring up the tiger trauma in the therapists office and shake the activation out of our bodies. It’s not to try to reason our way out of the activation with our friends or therapists, by trying to talk our bodies out of the activation using reason. And it’s not to go to the tiger exhibit and try to sit there for five minutes while our bodies freak out, white knuckling an exposure that feels like we are in danger, but that we just happened not to die this time. And again, all of these strategies made sense when we didn’t know what exactly was working and we saw that these strategies worked sometimes for some people. It is good scientific instinct, in the absence of knowing which variable works, when it works, to preserve all the pieces. But now that we’ve mapped out the pieces across all the fields of science that weren’t talking to each other, we can simplify and clarify what’s needed.

What we actually need to do is go to the enclosure, and notice. Notice the activation in our bodies. Like a scientist, you can feel what’s going on in your body, what it feels like when those chemicals get pumped through your system, what your muscles do, what your thoughts do. What your body wants to do. Does it want to run? Does it want to hunker down and hide? And then, with the physical sensations online and allowed to be there, we also need to bring our conscious awareness online. We need to show our body through thoughts and actions, there is a tiger and that feels scary, and now I’m at the zoo, and there’s thick glass between us, and I’m not actually in danger. We can allow the feelings and maybe even touch the glass. The activation may get really strong, we may want to collapse, or run, or feel like we’re going to burst into tears. These are the things that would signal retraumatization to some therapists, but the reality is that our system is just doing what it should be doing, ramping up the response to get you to listen. But you can tame the beast inside that’s telling you to run by showing it that you don’t need to, that this is safe. This is how we update our threat loops. By taking the bull by the horns and showing it that this isn’t dangerous. And then doing it again the next time. And the next. Until the tiger-behind-glass stops firing the cascade at all. Because remember from the extinction science, likely our amygdala will always fire the threat response when we see the tiger, but through this learning, we can wire in safety so our prefrontal cortex fires the inhibition signal that stops the cascade before it takes over.

And by doing this with our knee jerk rumination or our threat reactions to our symptoms or to the myriad other things our bodies wire in responses to, we can inhibit the threat response across contexts, and turn off the engine driving the pathostatic chemistry in our bodies.

And if this sounds a little fantastical as a way to address chronic diseases, think for a minute about the paper rose lady again. Allergies aren’t just some vague ‘symptoms’; they aren’t just stomach upset or fatigue or a headache or the other things people generally dismiss as not that serious. Anaphylactic shock, which is at its core just a really severe allergic reaction, can lead to death. Literal death. And people are having these responses to peanuts, and bee stings, and other things most people can experience with no problem at all. And medicine is actually able to treat these extreme reactions, and get people’s bodies to stop reacting this way to these non-threatening stimuli. Because they are, ultimately, non-threatening. If people were biologically allergic to things, if that were coded into our DNA, then it wouldn’t be something we could train ourselves out of. But it is. It’s done all the time. The way it works is that they give you just a little bit, a trace amount, of the thing your body is reacting to. Then over time they increase the amount, and your body learns to stop mounting a response. This is neuroplastic conditioning in action, and this treatment is used at major medical centers across the country, because they understand that it can help people’s bodies stop reacting. What they may not understand is that all you are doing through this process is teaching the threat response to stand down and stop reacting to things that aren’t dangerous.

Allergies are unique because the threat is “external”, at least in part. Not for the paper rose lady, since that rose wasn’t real, but in the sense that you can say ‘I’m going to inject you with this threat and show your body that it’s not actually dangerous.’ We can’t do that with internal processes, internal symptoms, thoughts, feelings, emotions - the things we are reacting to most of the time throughout our days as threats. So we have to show our body the same thing from the inside. Just like medicine does with these allergens, we have to show our body that these things aren’t a threat and that it can stop mounting the response it has gotten so good at mounting. That’s really all there is to it. And it’s really simple, but it’s definitely not always easy.

Why this is hard

We have 500 million years of evolution telling us to do exactly what we’re doing. The neuroplasticity that changes our brains and helps get us stuck? That exists in animals too, as evidenced by the Merzenich monkeys and decades of other neuroplasticity research. The reason we are able to use animals to test drugs and reactions is because they are so similar to us. If rats were fundamentally different from humans they would have no utility as our test subjects.

So our brains are doing exactly what they were evolved to do over 500 million years; of course trying to get them to function differently is going to feel not just hard, but wrong. It IS wrong, evolutionarily. Our brain is trying to keep us safe from threats. Telling our brains to stand down, that’s unnatural. If you’re running toward a fire, your brain is going to tell you to stop. That’s normal. But firefighters are able to tell their brains: I have protective gear on, and I have a good reason to do this. I’m going to do it and it’s safe and ok. They learn to run into a fire. We can learn to turn off our rumination and stop responding to our physiological activation like it’s a life or death threat in a similar way. It’s not easy but neuroplasticity and our human cognition make it possible.

Another reason this is hard for people is that they often don’t know they’re activated. There are lots of people with heart disease or cancer or any number of other chronic diseases who would tell you that they aren’t “stressed”. And they would be right, they aren’t stressed in the way we’ve been taught to think about it. What we are talking about here with pathostasis is something different. And it can look two different ways. If you think about the PAG switch we talked about in chapter 10, there are two modes: the mobilizing PAG, which is the fight or flight response, the one most people think about when they think about our threat response. And the immobilizing PAG, which is freeze or fawn, and often looks much different than what we think of colloquially as stress.

Getting caught in a mobilizing feedback loop typically looks most like being stressed as we think about it. But it’s not to be confused with just feeling stressed about your emails or the upcoming holidays. This typically feels like being anxious, or ruminating all the time, or getting stuck thinking about stressful things. Often in this version, the feeling of activation itself becomes a threat, creating a feedback loop. And another key hallmark of this version once someone is sick is that symptoms themselves become triggers. So the pathostatic chemistry and stress feelings cause symptoms, and then the symptoms cause activation and the activation causes more stress and more chemicals, and this becomes a feedback loop that gets more and more entrenched the longer it runs. These people tend to know they’re activated or stressed, but because the cultural narrative is to do more self care (state changers) or eat better food (external inputs), they don’t think about it in terms of “I’m in pathostasis and I’m stuck in a loop.”

The immobilizing feedback loop looks a little different. From the outside this can look like someone who seems a bit emotionally flat and not very reactive. Someone who seems to just go with the flow, but not in a way that feels happy and engaged, more in a way that seems just…neutral. These people tend to have less intimate relationships, because their survival mode is to shut down emotional responses. The chemistry for these people is kept on because emotions feel like a threat, so every time they feel them their brain triggers the immobilizing PAG response, which keeps the pathostatic chemistry going and keeps them in shutdown. These people likely don’t think of themselves as stressed, and the people in their lives probably don’t think of them as stressed. They seem more neutral and mostly just fine. Not too happy, not too sad, just existing.

And people don’t have to be just one or the other, one person can have both bowls. But the reason attachment theory took off the way it did was because people seem to default more often to one or the other. Most people have both, but oftentimes one is far more entrenched neurologically than the other, which means it pulls you in more often. And the more you’re in it, the more that bowl gets wired in, the stronger the pull becomes.

Entrenchment

While everyone can do this work, it’s important to acknowledge a few things. One is that the longer you’ve been sick and stuck, the harder it is. If you remember from chapter 9, the longer you’re in pathostasis, the more your brain remodels to encourage those same patterns. Not only do you build Merzenich maps from practicing the same symptoms and conditions over and over, but under these conditions the research shows your amygdala grows bigger and more connected, more sensitized and ready to trigger your threat response, and the brakes of this response, the prefrontal cortex and the hippocampus shrink and become less connected. Which means that it’s easier to maintain pathostasis and far harder to reverse it. This is why long covid isn’t considered long covid until 3 months have passed, because until that point spontaneous recovery is still possible. Your attractor state of covid symptoms isn’t so entrenched that you can’t just jump out of it into another bowl. It’s why depression shows better treatment outcomes the earlier you get treatment; patients who get treated early have nearly four times better odds of achieving remission than those who wait. Because the longer we are wiring in these reaction patterns and the more our brain is getting physically remodelled to promote these states, the harder it is. This is not to say that people who have been sick a long time can’t get better, they have and can. It’s just important to acknowledge that the timeline may be longer and the work may feel harder.

And the other big consideration that deserves being addressed is that healing isn’t equal opportunity for everyone. If someone is living in constant stress, working three jobs to make ends meet, has abusive bosses, or is living in unsafe conditions etc, healing will just be harder for them. If your life circumstances are contributing to your pathostatic load, and they are unchangeable, then this gets way way harder. Sometimes when there is a solution like this that requires individual action, it can lead to blaming people for being sick, or people feeling like they are being blamed. We want to avoid the trap of becoming unfalsifiable like Freud and saying if you heal it proves the model and if you don’t you weren’t trying hard enough. This is not easy and it requires a certain amount of space to be able to do. Not everyone has that space. But for those who do, or who can create even a little, the path is clear.

Unnecessary complexity

Similar to how medicine saw the complex outputs of chronic diseases and assumed the mechanism needed to be equally complex, we have seen the complex output of our disease and suffering on an individual level and we think that it requires an equally complex solution. That if it took years to wound us, it should take years to recover. That we need to excavate the meaning, understand the origins, process the feelings, and integrate the parts. The complexity of the healing ritual can feel like it validates the significance of the pain.

But now with the science laid out for us, we can see what the active ingredients are, and we can simplify and speed up the healing process. And having the science also validates our suffering in a way we’ve never before been able to see clearly. Whether you have a “real” disease, a “psychological” disease, a “functional disorder” or something completely unnamed, we can now see that it’s all the same process: pathostatic chemicals changing your brain and your chemical composition and your physiology at a full body scale. Those changes causing predictable downstream dysfunction like vasoconstriction and glucose elevation and clearance failures that lead to all of the diseases that we have defined. This then creates attractor states that can run for years or decades. All of this is expected given our 500 million year old threat detection system as it’s now paired up with our human cognition. It’s all the same thing, and it’s no one’s fault. And now we have the simple map to what actually works to address it, rather than complex rituals or external optimization.

With all of this knowledge, it becomes clear that addressing illness and suffering demands a reframe. That healing is not, can not be, a destination. It is lifelong. And maybe, just maybe, that can be ok. Now that we have the answer.