The Hidden Core of Medicine’s Burnout Crisis: “One Who Cannot Be Pleased” & The Not Enough Loop

 Medicine, as a profession, has long been structured around ideals of perfection, self-denial, and relentless striving. But beneath the surface of its institutional and cultural demands lies a deeper, more insidious psychological pattern—one that operates both externally, shaping patient-clinician dynamics, and internally, driving physician burnout and self-invalidation.

The Divergent Meridians: How Neurology Illuminates a Classic Framework

The Divergent Meridians and Autonomic Imbalance

The divergent meridians occupy an esoteric and enigmatic position within classical Chinese medicine. They appear in the historical record earlier than the eight extraordinary vessels, yet their purpose and use remain shrouded in mystery. Unlike the primary meridians or the Eight Extraordinary Meridians, which have more defined functions and methods, the divergent meridians have no clear consensus on their clinical use. Many modern practitioners never use them.

Character Analysis: "One Who Cannot Be Pleased" – The Inner Critic: A Blended Personality Defense

Overview: The Multi-Layered Defense of Judgment, Expectation, and Emotional Disconnection

This character structure represents a complex blend of Rigid, Psychopathic, and Masochistic defenses, creating a personality that operates through expectation, derision, and strategic invalidation to maintain control over their environment. This is not a single defense pattern but a layered adaptation—a personality defense constructed to protect against deep-rooted feelings of inadequacy and rejection.

Mindfulness, Autonomic Regulation, and Primitive Reflexes: A Neuro-Somatic Framework

My first introduction to deep somatic work was over 30 years ago with a clinician who had abandoned her psychology license to integrate hands-on therapies. With three PhDs, she realized that dissociated trauma survivors were cognitively processing their pain without ever truly feeling it in their bodies. This recognition was foundational in my understanding of why mindfulness must be embodied.

Mapping Blended Character Structures to Socialization & Trauma Patterns

 1. The Role of Developmental Trauma & Limbic System Imprints

• Heller’s NeuroAffective Relational Model (NARM) mapped character structure to developmental timing, showing how different trauma ages create distinct emotional & autonomic imprints.
• We already see this reflected in primitive reflex retention, which anchors survival responses in the nervous system.
• Relational trauma doesn’t just “cause” personality traits—it shapes how autonomic patterns embed into perception, behavior, and relational dynamics.

Master Integration: Regulating Autonomic States Through Neuro-Somatic Interventions

This section synthesizes strategies for **all three autonomic dysregulation states—Dorsal Freeze, Hinge State, and High Arousal—**providing a comprehensive neuro-somatic intervention framework. While many strategies apply universally, each state requires nuanced application based on its neurochemical, autonomic, and physiological profile.

Introduction: Understanding Autonomic Dysregulation (4) - Yin (Dorsal) Vagus and Mixed Patterns

 Parasympathetic Dominance: The Dorsal Vagal Freeze Response

The dorsal vagal freeze response represents an extreme parasympathetic state, where the body enters a shutdown mode due to overwhelming stress. Unlike typical parasympathetic activation, which restores balance, the freeze state represents pathological yin—a state of hypoactivity and stagnation. In this state, the body cannot access the vagus nerve, blocking the usual parasympathetic calming response. This leads to a complete collapse of normal autonomic regulation and function. The system enters a hibernation-like state, and the body cannot respond to external stimuli, including stressors.

The Bibliography

In lieu of a references page for each blog post, I have an included the references for the entire subject, to be expanded as content increases. For ease, I reference the last name of the author in the blog paragraph for more important works.  Polyvagal Acupuncture (TM) and all materials are trademarked intellectual property. Please do not use without a reference.

Integrative Neurology: Redefining Trauma for TCM

Trauma refers to an overwhelming experience that exceeds the parasympathetic buffering capacity of the autonomic nervous system (ANS). It can arise from physical injuries such as traumatic brain injuries (TBI), natural disasters, or a life-altering medical diagnosis. Trauma also includes emotional experiences such as death, divorce, migration, or the loss of a home. These events place tremendous demands on the ANS, resulting in observable shifts in blood flow, oxygen delivery, body fluids, and vital resources as the body prioritizes survival.

Hypoxia in Long COVID and Its Impact on the Krebs Cycle

The Current Understanding of Long COVID in Western Medicine

Long COVID, officially known as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), remains a poorly understood condition despite its significant prevalence and impact. Western medicine has identified common symptoms such as fatigue, brain fog, dysautonomia, and exercise intolerance, but the exact mechanisms driving these symptoms remain elusive. Hypotheses center around immune dysregulation, persistent inflammation, mitochondrial dysfunction, microclots impairing oxygen delivery, and potential viral persistence. However, no definitive cause has been established, and treatment options are largely focused on symptom management rather than to address underlying dysfunctions. While progress in research continues, Long COVID highlights critical gaps in understanding chronic, systemic illnesses within the Western medical framework.

The sympathetic dysregulation seen in long COVID is not just about the physical symptoms, which are crushing, but about the broader systemic effects. PT, RT, and rehabilitation cannot succeed under parasympathetic dominance (freeze states) or mixed autonomic patterns because the immune system shuts down. Extreme autonomic dysregulation, compounded by hypoxia, limits the brain’s capacity for neuroplasticity. Cranial nerve involvement often indicates a partial dorsal freeze state and the loss of this capacity.  Recovery from long COVID requires rebuilding autonomic pathways in the vestibular system and addressing spasticity in tissues, which are replaced rather than repaired. Ancillary providers play a role by helping to maintain autonomic balance which allow the brain to create new pathways. This process cannot be resolved by medication or steroids; rather, patients must reintegrate portions of their nervous system. Collaboration across modalities is essential, and PT, RT combined with ancillary techniques and minimal supplementation support the internal processes so that PT and RT can be effective.