Fight or flight response: when the lion isn't real

My mentor had a phrase for the stress most of us carry all day: real but not true. Here's what he meant, and the simple check he taught me for it.

Most of the emergencies your body reacts to in a day aren't emergencies at all, because your fight-or-flight response can't tell the difference between a lion and a late bus. It runs the same chemistry either way. I learned this from my teacher, Dr. Gerald Epstein, and in a recent class I walked through what he called the false emergency state: what it is, what it does in your body, and how to step out of it. This is for anyone who gets to the end of the day with tight shoulders and no clear idea why.

The teacher behind this class

I studied with Dr. Gerald Epstein from 2004 until he passed away in 2019.. Jerry, as I called him, was a psychiatrist in New York who had learned a technique of mental imagery from a teacher in Jerusalem. For me, those years were almost a second medical school, and they changed how I see patients.

My father, an old-fashioned family doctor who took me along on house calls, had the other half of it. He listened. Sir William Osler put it simply: listen to the patient,, they're telling you what's wrong. Nobody knows what it's like to be inside your body better than you do. So as you read, check everything here against your own experience. That's how you become your own authority in health.

What a false emergency is

Jerry defined it as a lived experience in which we falsely believe we're facing a threat to our existence. Your body reacts as if a lion is chasing you. There's no lion.

His phrase for it was "real but not true." The experience is real. The racing heart, the damp palms, the knot in your stomach are all really happening. What isn't true is the thing your body believes, which is that your life is on the line.

Think about how often this happens. You run for a bus before the doors close. You wait for an important phone call that doesn't come. You drop a glass in a quiet restaurant and feel the heat rise in your face. You watch the market fall on the evening news, or you start worrying you might lose your job. None of that is good news. None of it is a true emergency.

Jerry's test was blunt. A true emergency is one where your life is literally at stake right now: a lion behind you, a gun to your head. By that measure, he'd say, about 99.9 percent of what we react to is false.

Why your fight-or-flight response can't tell the difference

Here's the mechanism. When you perceive a threat, your body launches one chemical cascade, and it's the same cascade whether the threat is a predator or a driver who cuts you off. Adrenaline rises. Cortisol rises. Stored fuel gets pulled out of your liver and muscles, so you have something to run on. Your heart speeds up, your muscles brace, and your breathing climbs up into your chest.

In a true emergency, all of that makes sense, because you use it. You run from the lion, and the running spends the chemistry. In a false emergency, there's nowhere for it to go. You're sitting in traffic with a body fully prepared to sprint, and the surge just sits there, keeping you braced long after the moment has passed.

Research on chronic stress points in the same direction. A 2016 review that pooled 60 studies found that worrying about the future and replaying the past were linked with higher blood pressure, faster heart rate, higher cortisol,l and lower heart rate variability, which is a measure of how flexibly your heart adjusts (Ottaviani et al., 2016). In other words, the thought alone can keep the alarm running. Jerry had strong words for the long-running version of this: "the physiology of death." He chose them on purpose, and he spent his life teaching the opposite, the physiology of life.

There's a cost to your thinking, too. When the alarm is on, the prefrontal cortex, which is basically the planning, reasoning part of your brain, goes partly offline. Even mild stress that feels out of your control can cause a rapid loss of those higher abilities (Arnsten, 2009). That's why you say things in the heat of it you'd never say on a calm afternoon.

I remember the first time this landed for me. I was on the 405 freeway in Los Angeles, someone cut me off, and I felt the whole surge go through me. And I thought, clearly, does my body really deserve this? All that hormonal energy, spent because some guy changed lanes.

The story is what keeps the lion running.

The trigger lasts a second. What keeps it going is the story we add. Say the market drops. The story, often without words, goes something like this: I'm losing money, so I won't make rent, so I'll lose the house. Each step feels like a fact. None of them has happened.

When a student slipped into this, Jerry would look at them and say, "Story, story." His reasoning was simple. If the story is about the past, it's done. If it's about the future, it's a probability, not a fact, and you've picked the worst one. In this moment, the market went down, and you're fine.

Most of those worst-case stories never arrive. In one small study, 29 people with an anxiety condition logged their worries for 10 days and then tracked what actually happened. About 91 percent of their worry predictions did not come true (LaFreniere & Newman, 2020). That's a small, specific group, so I wouldn't stretch it too far. But it matches what most of us find when we look back honestly.

It can help to name the category. Napoleon Hill's Think and Grow Rich lists six basic fears: poverty, criticism, ill health, loss of love, old age and death. Almost every false emergency fits one of them. And every one is a story about what might happen, not what is happening.

The space between the lion and your reaction

There's a line usually attributed to Viktor Frankl, author of Man's Search for Meaning, that I come back to constantly: "Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom."

Without that space, we're a keyboard. Someone presses A, and A pops up. That's a machine. I think this is one reason so many traditions put a prayer between making a meal and eating it. It's a small, deliberate space, so we're not just reacting.

At first the space is tiny, a fraction of a second. With practice it starts to feel longer, and there's room to choose.

Jerry's most practical tool for making that space was to use your own name. In my case: "Jonathan is creating a false emergency." You say it in your head, or quietly out loud. Using your name puts a little distance between you and the event, almost like watching yourself from a corner of the room. There's research behind this. In a pair of lab experiments, people who reflected on upsetting images and memories using their own name instead of "I" showed less emotional reactivity in their brain activity within the first second, without signs of extra mental effort (Moser et al., 2017). The authors called it a relatively effortless form of self-control. Jerry's shorter version: you're reporting fake news to yourself.

Notice where your body is holding the lion.

Before you can question a false emergency, you have to notice it, and most of us have lost touch with our bodies. Years ago in Los Angeles, I studied the Alexander Technique with a teacher named Michael Frederick, and it taught me to see the posture of emotions. Shoulders pulled up with the head pushed forward is a classic fear posture.

I see it in the exam room. I'll lift a patient's hands to look at them, move on to listen to their lungs, and their hands are still hanging in the air. Other people are loose. You pick up their hand, and it simply drops.

Try this now. Start at your feet and move up: calves, thighs, back, shoulders, neck, jaw. Where are you holding? Then notice your breath. Is it up in your chest, or can you let it settle down low into your belly for a few slow breaths? And is there a background hum of worry you've stopped hearing? That hum is usually a stack of small false emergencies nobody questioned. Like anything else, noticing gets easier with repetition, because the habit is the result.

Questions I get about this

Isn't some stress good for you?

Yes. Short, real stressors you recover from, like a hard workout, can make you stronger, and I teach that often. The false emergency is different because the surge never gets used and never gets a chance to resolve. It's the alarm that stays on.

What if the worry is about something real, like money or my health?

That's exactly what "real but not true" is for. The problem may be real, and it may deserve action. But your life isn't at stake this minute, and a body braced for a lion won't make a better phone call or a better plan. Do what you can right now. The outcome isn't fully in your hands anyway.

Doesn't talking to yourself in the third person feel silly?

A little, at first. Do it in your head if you like. The point is the distance it creates, and that works whether anyone hears it or not.

How long before this gets easier?

It's a practice. It won't be perfect right away. But in my experience, the more you do it, the less automatic the reaction becomes. If stress or worry feels constant or overwhelming, bring it to your own doctor. This is a way of paying attention, not a substitute for care.

References

1. Ottaviani C, Thayer JF, Verkuil B, et al. Physiological concomitants of perseverative cognition: A systematic review and meta-analysis. Psychological Bulletin. 2016. PubMed
2. Arnsten AF. Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience. 2009. PubMed
3. LaFreniere LS, Newman MG. Exposing worry's deceit: Percentage of untrue worries in generalized anxiety disorder treatment. Behavior Therapy. 2020. PubMed
4. Moser JS, Dougherty A, Mattson WI, et al. Third-person self-talk facilitates emotion regulation without engaging cognitive control: Converging evidence from ERP and fMRI. Scientific Reports. 2017. PubMed