Decoding the Nervous System: A New Clinical Lens for Chronic Illness

Introduction: The Missing Piece in Patient Care

You can have the cleanest protocols, ideal lab markers, and a motivated patient, yet still see no real change. For many practitioners, this disconnect leads to tweaking interventions or questioning the diagnosis. But the problem may not be what you’re doing. It may be the state the body is in when you do it.

In our Primal Trust™ Practitioner Training, Dr. Cat presented a clinical lens that prioritizes nervous system state over protocol. She reminded us that nervous system regulation is not supplementary. It is foundational. Until the body feels safe enough to receive care, healing will remain stalled.

The State Shapes the Outcome

Most of us were trained to look at symptoms and prescribe action. A new complaint triggers a change in treatment. But rarely do we pause to ask what nervous system state the patient is in when that symptom arises.

According to Dr. Cat, every autonomic state changes the immune system, hormonal output, detoxification capacity, and even the brain’s ability to process information. A patient in a dorsal vagal collapse will not metabolize your recommendations the same way as someone in a ventral vagal state of connection. It’s not that your protocols don’t work. It’s that they cannot land in a system that is not ready.

“You can’t just treat the symptom. You need to track the state and adjust your approach accordingly, and teach your patient to do the same.”

When we begin to track state as carefully as we track symptoms, we move from reaction to relationship. This is where long-term change begins.

It’s Not Just Fight, Flight, or Freeze

In many clinical models, we learn to identify three basic states: sympathetic (fight or flight), dorsal vagal (shutdown), and ventral vagal (safe and connected). But as Dr. Cat explains, there is more nuance to the nervous system than these three categories allow.

There are blended states, including high-functioning freeze, where the body appears active and capable on the outside, but internally is stuck in survival mode. Many practitioners live in this very pattern themselves. They show up, they perform, they serve others. But inside, their own nervous systems are exhausted and unresourced.

This state is not sustainable for clinicians or patients. Without recognizing it, we risk creating protocols that override rather than regulate.

When Progress Feels Like Regression

A key insight from this class is one that challenges conventional assumptions. Dr. Cat explains that many patients begin to feel worse when they finally start to heal. As the nervous system moves out of collapse and begins to mobilize, sympathetic energy rises. Patients may feel anxious, irritable, restless, or even panicked.

This is not a setback. It is a sign of thawing.

“Anxiety after shutdown isn’t a setback. It’s your system waking up.”

This phase is often misinterpreted as treatment failure or a return of symptoms. Patients may quit the work. Practitioners may second-guess the plan. But if we can understand and educate around this pattern, we can support people through the temporary discomfort that precedes true healing.

Interoception as a Clinical Tool

One of the most transformative teachings from this session centered on interoception, which Dr. Cat defines as the ability to feel internal body signals like heartbeat, tension, breath, or gut sense. Many patients, especially those with trauma or chronic illness, lose this capacity. They become disconnected from their own felt experience.

“You cannot regulate what you cannot feel.”

Without interoception, patients often rely on hypervigilance and fear to navigate symptoms. The body becomes something to manage or suppress, not something to partner with. What many call intuition is actually limbic overactivation.

Helping patients recover this inner sense is central to nervous system regulation. It gives them back agency. And it does not require complex therapy. It begins with simple practices of orientation and pause.

The Role of the Practitioner is Evolving

This training challenges us to examine our own presence. Dr. Cat reminds us that regulation is not something we just teach. It is something we model. A single breath before walking into a room, a moment to ground, a pause between words—these are not luxuries. They are clinical tools.

“When you show up regulated, attentive, and calm, you’re offering more than clinical care. You’re offering co-regulation.”

The nervous system responds to nervous systems. No protocol can override a practitioner’s energy. If we are dysregulated, our patients may not feel safe, no matter how compassionate our words or accurate our assessments. Healing requires congruence. That starts with us.

Closing: Start with Safety

Before you adjust another protocol, consider the state of the system it is landing in. Nervous system regulation is not a side note in chronic illness care. It is the gateway.

Progress may not look like immediate symptom relief. It may look like a patient noticing their breath. Making eye contact. Feeling hunger again. Experiencing a sense of safety for the first time in years. These are not small wins. They are signs the body is listening.

Dr. Cat said it simply and clearly.

“The nervous system is not a side note. It is the foundation. And when we honor that, healing becomes possible again.”