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The Big Bang Theory, I watched that.
Okay, so the role that you played and the role that Sheldon played were faces that were not animated, voices that didn't have intonation and all the consequences of that in the social interactions.
And the other part was that these are bodily feelings that would trigger others, but it didn't mean that your own images of what you wanted out of life were different than everyone else's.
See, that's the interesting part.
Even with people who suffer from severe trauma, their physiology is disrupted and their bodies aren't safe in the presence of another.
But it doesn't mean that their visualization, their dreams, aren't to be held comfortably welcoming, in the arms of another.
We live in a world that we think that removal of threat is our goal, is our responsibility.
I'm saying it's important to remove threat, but it's not sufficient.
So think about schools.
We put metal detectors or want to give guns to teachers.
It's going to be more triggering to the students, because that is not.
Those aren't signals of safety.
Their body doesn't want to be injured.
So signals of threat are important to be ameliorated, but signals of safety are obligatory for our bodies to feel safe.
And we haven't even thought much in our society or schools or medical environments.
Or prisons.
Yeah.
Any of our institutions that signals of safety enable people to be more humane, more nicer smarter, healthier.
We basically throw it back at the person and say, it's your responsibility.
We treat it as intentional as opposed to being reflexive to the signals in the culture that we're living in.
It's Mayim Bialik's Breakdown.
She's gonna break it down for you.
Because you know she knows a thing or two.
So now she's gonna break down.
It's a breakdown.
She's gonna break it down.
I'm Mayim Bialik.
I'm Jonathan Cohen.
And welcome to our breakdown.
This is a place where you break things down so you don't have to.
Today, we have a very sexy episode for you.
It's super sexy.
All the rage with the kids.
We're going to break down the vagus nerve.
And if my voice just made you feel unsafe, it's because your vagus nerve doesn't like that frequency.
Maim, if no one's ever heard of the vagus nerve, tell them why.
It's the most important part of the body that they may not have ever heard of.
Well, the vagus nerve is the 10th cranial nerve and it winds on a beautiful journey, a beautiful journey from the brain throughout your body to all of the organs that we associate with gut instinct, having an open heart and even being able to metabolize food and take in sensory information.
It's the only nerve that does the kind of dance that it does.
And we're gonna be talking to Dr Steven Porges, Distinguished University Scientist at Indiana University.
He's the founding director of the Traumatic Stress Research Consortium.
And he is the dude who created what is called polyvagal theory, which is an understanding of the vagus nerve and the several branches of the vagus nerve and how they innervate so many fundamental parts not only of the body and the brain, but of the human experience.
He's written a book called Our Polyvagal World.
He actually wrote it with his son, Seth Porges, a very, very distinguished documentary filmmaker who you may have heard of.
And it's how safety and trauma change us.
And we're going to talk to Dr Porges about what the vagus nerve actually is, what it does.
Can you hack it or not?
What is it communicating and literally, how can understanding this one nerve change our human experience as safe or not?
We are thrilled to welcome Dr Stephen Porges to The Breakdown.
Break it down, hi maya.
Uh, before we begin, you know my wife.
I know your wife so well and i literally just pulled up my thesis because well, i'll go ahead and tell you so.
When i opened up your book and i've i've known who you were, i just had not read any of your books.
So I open up your book and I look at your dedication and I'm thinking well, that's interesting.
He's dedicating this book to Sue Carter.
And I thought, I can't wait to figure out why.
Like it didn't put it together.
And I'm reading and I'm reading.
And then we get, I don't know, however many chapters in.
And then I realized, oh my gosh, right.
This is Sue Carter's husband.
And so I pulled up my thesis and She was not part of my dissertation committee, but it says.
I wish to thank the incredible Sue Carter, both for the use of her laboratory for our oxytocin and vasopressin essays I might cry now as well as for her time spent editing chapters one through four.
Through numerous emails and telephone communications, I've been lucky to have one of the world's foremost authorities in hypothalamic secretion supervising my progress and assisting me, for which I'm very grateful.
I think she has the most citations ever. single citations of anyone in my thesis.
And it's so lovely to get to talk to you.
Well, I'm glad you got to meet the better part.
That's good.
I'm sure you have noticed that the vagus nerve is having its moment.
It's having its moment on TikTok.
It's having its moment on the internet.
And you have been part of the understanding of the vagus nerve for decades.
I'm curious if you can reflect, as the guy who literally came up with the theory, that turned out to be very true and incredibly meaningful.
What are people picking up on?
What is this fascination with the Vegas world?
Well, okay, we live in a strange world, or maybe it's a simple world.
We live in a world that orients itself into believing that things are cause and effect.
So they're actually misinterpreting so much about the Vegas.
They give it literally decision-making abilities.
They try to hack it.
They try to pray to it, literally.
And basically, all it is is a wire.
You know, it's a conduit.
And if they took the metaphor of a conduit and saying this is a wire that connects the brain to the organs of the body, and it's bidirectional.
Wow.
Then you start getting insights into you know mind body brain, body issues, how stress works, how how feeling good affects how we think.
You know, in a sense, if our body feels good.
And it would lead to a redefinition of terms like anxiety and stress.
Throw it out of the psychological realm and say look, my physiology has shifted to a state of defense.
If I'm in a state of defense, I'm not going to be a loving person.
It's the end of story.
I'm not going to be smart either.
And that's very relevant to our contemporary world.
As we can see, behaviors of many, once they get angry and upset, they're not good problem solvers.
You said three things.
If your vagus nerve is, let's say, giving these kinds of signals, you're not going to be a good problem solver.
You're not going to be in a good state of mind.
Why do you say you won't be smart?
Oh, you can't recruit the higher cortical areas for decision-making, for executive function.
You're a brainstem preparation, literally.
You're a threat.
You're a defense machine.
It means you're good at defense. but it doesn't mean you're good at problem solving.
We have trade-offs.
So when we are in a sense social loving, kind supportive, we kind of turn off our defense systems.
We're not good fighters at that moment.
And when we are very involved in objects or intellectual processes, same thing.
We're diverting our resources.
So it's a resource allocation.
And the vagus is kind of our partner between these higher brain structures and our resources.
The problem is, and this is where this whole issue about the vagus is, there's an acknowledgement that something's gone wrong in our periphery and that information is being conveyed affirmatively, sensory, up from the vagus to our more aware brain.
So we think we can fix it by changing the signals in the vagus, when that's really just giving us a portal into the disruptive regulation of the system.
So it's the way we think that doesn't lead to, let's say, reinvesting and understanding that our nervous system is a dynamically organized.
It's a system
It takes input, takes output, it regulates.
It's not just, oh, I don't have enough of this.
Let me stimulate it some more.
It's like saying, let me assure that it doesn't have to be used for defense.
Now it will do its job.
Well, a lot of the TikTok memes are about stimulating the vagus nerve, because people believe that stimulating it is going to produce the feeling of not being stressed.
But what you're saying is you have to produce the feeling of not being stressed and then that will travel the wire in order to get the message where it needs to be.
What do you think about, you know, people talk about humming.
Humming is remarkable.
It's actually so.
If you have a theory, the theory is how do you stimulate the area of the brainstem that will produce the calming?
Calming is one of those.
And actually the whole utilization of the muscles of your face and head are connected in the brainstem to the vagus, the part of the vagus that does the calming that goes to your heart.
So we actually hear in people's voices whether their physiology is calm or not.
We see in their faces whether they are accessible, comfortable in their bodies or not.
So we project that and we broadcast our physiology.
So once we understand that we are really the producers of our own states, we have different options.
Humming is one of them, by the way.
Okay, so humming is good.
Singing is good.
Singing is good.
Playing wind instruments is very good.
Talking, talking, extending durations of your phrases.
So-
How many interviews have you done now on the podcast?
How many?
Hundreds.
Pushing 200, and I speak too fast in all of them, Dr. Porter.
No, not you.
I don't want to evaluate you.
I want you to evaluate the people you've had on.
So there are going to be some people who talk in very short phrases, take breaths in the middle of sentences.
Oh, wait, I have a question.
Some people have a speech pattern that makes me very anxious.
And I'm, and like my, my parents are from the Bronx.
Like we talk fast.
If you don't like interrupt, you don't get heard.
But sometimes people will speak and it's very like staccato and I can tell that there's anxiety and it makes me want to crawl out of my skin.
Is it because my Vegas is mad?
No, no, but it affects your vagus.
So this is the story here.
This is what I call the social engagement system.
It's the utilization of all the striated muscles that are linked with the face and the head.
And in the area of the brainstem where they are controlled, happens to be what I call the ventral vagus, the vagus of calming of your heart.
So that enables us to broadcast our own physiological state.
So these people are broadcasting to you a physiological state of threat.
Now, what does your nervous system do with someone who is expressing threat to you?
You react to it.
You're human.
So it's a very natural bit.
But so you are basically, your feelings of, hey, I'm uncomfortable here.
You're uncomfortable because the signal is a signal of threat.
And it's evolutionary.
It's wired into you.
It's not something that you can say, oh, you know, over time, I'll get used to it.
I'll just smile and let it flow off.
When you start doing that, you actually start to dissociate.
And you probably do that with these feelings.
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You talk about people sending threat basically, or things that are being perceived as threat by someone else.
So for Mayim, it's that choppy speech pattern.
What are we human beings?
Maybe us in this podcast, or people more generally?
What are?
What are we sending that we don't realize is threatening to others?
Okay, so let's start off by changing the language.
We're going to get rid of words like perceive and use the word detect and place it at the level of a nervous system detection which does not require our, let's say intelligent, aware brain acknowledging it.
So we detect, our nervous system detects it and it detects it.
It carries with it a reflexive physiological shift.
That we are aware of.
We are aware of our physiological shift.
That's what Mayim's describing.
Her nervous system detects this pattern.
It's an evolutionarily wired into her system.
She's being bombarded with signals of threat.
And her nervous system is saying, hey, get me out of here.
This is not comfortable.
But also there's variability in this meaning.
I often, as a person with a very interesting history, I tend to pick up on things that other people don't pick up on.
I tend to feel threatened when other people don't feel threatened.
Sometimes those kind of voices don't bother other people, but they bother me.
So what is that?
Well, that's really acknowledging that you're human.
Okay, so it's not like you're not going.
I can praise you and say well, you're just remarkably sensitive.
But then you might say, well, I'm too sensitive.
How do I downregulate that?
We get into this.
The part is we can literally map this into what we call spectrum disorders.
You know, people who are more or less attuned to other people.
We can talk about it as a degree of sociality.
We can talk about it in terms of how we deal with pets.
So with pets, we talk to them in the same melodic way.
But the secret.
I mean, you're actually living through perfect examples of this remarkable neural circuit that we have that enables us, as social mammals, to calm each other.
So this has been the go-to way of reducing stress.
So when a person is talking that way to you, It's not like you say oh, stop talking to me with that hostile voice.
No.
You would basically, if you wanted to calm them, you say, hey, what's going on?
You know, like witnessing them, being present.
This is what good therapists do.
They don't tell people that they're doing something wrong or bad.
They're saying, let me listen to you.
Let me hear what you have to say.
Being present is a very powerful tool. part of a co-regulatory process.
And what you're really describing is really co-regulation.
We as a species like to interact, but that interaction requires a degree of reciprocity.
You talk, I listen, I listen, you talk.
If it's really important, you talk and I stop.
So we go back and forth, we roll reverse.
And this is kind of something we watch in healthy people where you'll have the sequential give and take and then there'll be a role reversal where someone will say oh well, tell me about how you feel.
And suddenly, you know, that's a relationship.
So our nervous system literally has these templates.
The bottom line is, yeah, you are sensitive.
But remember, if you come from the East Coast and you carry with you certain transgenerational history,
I wouldn't even use the word trauma.
The language.
The use of language, the use of body posture, the use of proximity is part of the culture.
And then what you start to study and this has really gotten me, I've gotten very interested in this is just kind of see where did this all come from?
And the part that we start learning is that Many of us are.
You know, my grandparents were the immigrants.
But they came from probably your great-grandparents.
They came from environments that were less optimal than what you're living.
My grandparents, no, my grandparents left Eastern Europe right before the Holocaust.
So it's real fresh, Dr. Borges.
Yeah, yeah.
Well, mine were the lucky ones.
They left 30 years before us.
But their relatives were all gone.
And the stories, those are the stories I heard as a child.
So the issue is you start to see their lives in perspective.
And you start realizing that when you lose loved ones in this horrible situation, are you safe?
Do you feel safe?
And then what, coming into this country, This country is very pragmatic in ways.
So how do you create safety?
There are two channels.
One is basic resources generate wealth.
The other one is education.
So you start seeing the adaptive function of the immigrant families and how they try to navigate within the US.
It's really remarkable.
If you think about it, as you said, it's really fresh.
Now, when you reflect on that, you say, what a remarkable story.
It's fresh, but look where you are.
And look at this transition that occurred so rapidly.
So I wonder if we can kind of take a step back.
I think that the vagus nerve you know, especially with its notoriety.
I mean Valerie, what's the statistic?
How many hashtags of the vagus nerve was there on TikTok or something?
Like 64 million.
Like everybody's talking about it.
It's very sexy, Dr. Porges.
Your vagus nerve is really, she's grown up so nicely.
But is this...
Is this what people are kind of treating it as?
I'm going to ask you, is this the most important body part that people don't know about?
Okay.
So it's like saying if I explain to you that there is a communication cable between your bodily organs and your brain, isn't that more important than the cable in terms of a metaphor or an understanding of health and relationships?
If I said to you, when your body is dysregulated, in a sense violates rules of health, growth and restoration homeostasis.
It affects how you see the world, how you think, how you engage others and how you feel.
Would that be important?
It would be sexy.
It's a very sexy idea.
Jonathan, I can see it in your face.
You're thrilled by this.
It wasn't that long ago that we didn't think that there was this interconnected relationship.
Listen, let me kind of give you, I think, what you want.
Okay, so when I started to talk about the Vegas, it was not even in the journals.
So you take a book, like major conferences at the NIH National Institute of Health on stress pick books.
The Vegas wasn't even mentioned.
And functionally what the vagus does.
It gives permission to the nervous system to react in threat to have those stress responses.
Because the vagus is basically an anti-stress system but it's not very adaptive to block those reactions, to protect yourself when you need to.
So stress is not bad, it just has to be appropriate.
And this led into all this confusing aspect about good stress, bad stress.
And it's just so confusing because they left the one limb of the nervous system off, this beautiful limb that has this ability to inhibit threat reactions the vagus.
How did you find it?
Because you don't just kind of become a graduate student and say I'm going to pick one of the nerves and I'm going to take the vagus.
Oh, you really want to go deep.
Okay.
Because narratives are as you already know.
People construct narratives and they can be very creative or they can be just very descriptive.
Okay.
When I started, no one really cared.
I can use all kinds of adjectives, but no one really cared what the neural mechanism was.
Physiology was literally treated as an observable behavior.
What were people interested in?
Yeah, I started off in when I went to grad school and this is really the world of 1966.
Emotion was not a valid research area.
Feelings, subjective feelings, those were not research areas.
I basically got literally seduced into this new emergent area called psychophysiology.
So the notion was that psychological phenomena could affect physiology.
And therefore, you didn't have to literally ask people what was going on.
You put electrodes on.
And what I noticed?
I noticed there was a change in heart rate patterns when people were attending sustained attention, mental effort.
I was very interested in that aspect.
And there was no explanation of the neural mechanism.
So I was seeing, actually I'm probably the first person to quantify heart rate variability as an individual difference and as a response variable.
I published on this in the 60s.
And now it's kind of like HRV all over the place.
But when I was doing it, my colleagues said heart rate variability.
You only are seeing that because you're a crappy researcher.
The heart should not have variability, because they had no idea about the neural regulation of the heart.
So that led me on this journey of an observable.
I saw the heart rate patterns.
I saw the rules that changed their heart rate patterns.
So I asked the next question, what are the mechanisms that are doing that?
Then the next question was, what are the metrics that I could develop to measure that?
And that was really the journey.
And that was the part that it led to, which I think is very important.
When I started We were in a world of stimulus response.
And so psychological phenomenon, physiological change, it's still SR stimulus response, still fitting in the worldview of what science is about cause and effect.
But what polyvagal theory, as it developed it, says that's not a good model of science.
It's too limited.
Basically, we have stimulation, we have an organism in the middle and then we have a response.
The characteristics of that organism tell you how that individual is going to respond.
So it was that intervening variable between the stimulus and response, between the cause and effect, that determined reactivity.
And by 1972, that was the focus of my research.
But it was the focus of my research.
In a world that said, if you don't get reliable changes on everyone, you messed up the experimental design.
Not that the organism had individual differences in features.
And you may remember from graduate school that there are certain data analysis models called analysis of variance.
Analysis of variance treats individual differences as error.
And fortunately, I will say, Statistical quantitative methods, psychometric methods have caught up.
We now call that mediation models or moderation models, where the intervening variable determines the relationship between stimulus and response.
And that's very close to where I am.
You talk about the notion of HRV, which I think a lot of people don't understand, and they don't realize why they should care about this as a health metric.
So it would be awesome to get that explained.
Yeah, okay.
So I think you're absolutely right, because it's been literally marketed and it's been marketed as an easily obtained observable that can be measured through wearables.
And the issue is yes, but you have to be real careful about the metrics that you apply, because not all measurements of HRV are equivalent, because there are certain components in that heart rate variability pattern that are easily definable neural regulatory components.
So we see a respiratory component, and that's called respiratory sinus arrhythmia.
That component, the neural mechanisms of that component are well understood.
That is that ventral calming bagel circuit.
And it was known since 1910 by Herring, if you ever run across him, that he was basically saying when you do your dissection and you're recording off the vagal nerve, you know if you have the cardioinhibitory fibers, if it has a respiratory rhythm.
So it's the functional output of that system gives you respiratory science.
And that has been my journey.
How do I create a better measure of that?
Because as you develop a better measure, you do better in terms of prediction of responses.
The things that people are measuring with wearables.
When you look at HRV, this is one of those things that a lot of people are being told you want a high HRV.
If you have a low HRV, it's a sign of this.
And I'll be honest, my teenager started wearing a wearable and he sleeps like a baby and he has phenomenally high, stable HRV.
And me, his mother...
I have really, really poor like I was hovering in the teens when I first got my wearable and I was not functioning well.
I'm still not functioning great, but I have been able to see the things that actually can lift this HRV.
Is this an accurate way for people to understand HRV and the vagus nerve?
Okay.
Okay.
It's not a bad way.
It's not the best way.
OK, it's like here's the big divide where basically, HRV is measuring heart rate and is measuring the variation in B2B changes.
Now the question is embedded in that variation are different neural signals, and HRV is a descriptive.
It's not a neural based metric.
So you have to go one step further.
And that's where I was going in the 70s, 80s, 90s, and continued to go there.
But the rest of the area said, oh, let's just call it HRV and run with this.
Because HRV, you can get increased heart rate variability with arrhythmias, with atopic beats.
And you have to be able to distinguish that from the rhythmic patterns of a neural feedback system that is working well.
And that's been my journey is increasing to get a neural metric.
The interesting part is that all this let's use the term hype and technology advances in sensors and wearables has not been to improve the ability to extract the neural influence, but to, in a sense, measure the physiological signal.
The physiological signal is a composite.
It's the intellect that we can use to break it apart and pull out these different components.
That is useful, most useful, I should say.
How do you get the neural signal?
Well, you basically use a signal processing algorithm that is tuned to take out this rhythmic component.
And so you have to build that into your algorithms.
So it's a different algorithm.
And for decades, I developed one.
I even had a patent on it.
It elapsed.
And over decades people were really trying to say well, that's just because you're saying it's better.
Okay.
And I'm saying, well, it's theoretically, here's the math.
This is it.
So I finally, this is in 2011, which is to me yesterday.
I had a good grad student.
I said, we're going to do this study.
We're going to use with college kids.
We're going to use partial vagal blockade and see which methodology is best.
So we can literally talk about what another evaluation size of the statistical effect is.
So basically, with the method I developed, it was four times better than the primary methods out there.
So it was a much stronger, better ability.
It didn't mean that the other measures weren't correlated with it.
They just were not as specific.
So finally, after, let's see, four decades, I was able to feel, yes, I was vindicated.
I had I've done something right.
But the issue is for most people, they don't really care.
They're just saying, do I have more heart rate variability?
And in general, the answer is it's not a bad estimate, but you can have really aberrations like arrhythmias.
And then you may be humming, I can't use that word here.
You may be thinking that you're doing fine and you really are vulnerable.
How much of mindset change and sort of thought patterns optimism, pessimism.
You know the intellect is playing into this and like is there any way yet to start to measure where people's thoughts are as it relates to their heart rate variability?
Okay, so this is actually the types of questions I had in the 70s.
Okay, it's like okay, what knowledge, what information can I get about a person by putting some electrodes on without having to talk to them?
Like the Muse headset, for example, or speech analytics.
Yeah, well, I will tell you.
We are now able to estimate vagal control of the heart from the intonation of voice.
That's why you know that.
Because that's also being regulated by a branch of the vagus.
It's also coming from the same area of the brainstem.
And that really was our evolutionary heritage as social mammals.
We were broadcasting in the intonation of our voice our physiological state.
And once you understand that, you know exactly what frequencies you should look at in the vocalizations.
You can build an algorithm on that.
So the part that what you can learn from putting those electrodes on is you basically can answer two questions.
One is the physiological state of the individual, meaning.
Is it really supporting homeostatic functions or is it really locked into a state of defense?
The second one, which I find really interesting, is how it dynamically changes.
So let's say, even with posture shifts or exercise, does it withdraw that vagal influence and does it come back on?
And I coined a metric there called vagal efficiency.
And I think that will map into many of the let's use the term disorders that are labeled dysautonomia POTS, irritable bowel syndrome basically, where people have autonomic anomalies that when they go to physicians the physicians basically say I just don't understand what's causing it.
You're fine.
To me, the organs are fine, but they're really not working.
So I think many of these features of what we call medically unexplained or functional disorders are really reflecting atypical neural regulation of that end organ.
So it comes right back to extracting the neural regulation.
So now here is the next problem.
In medicine, whenever you go in for an assessment and assessments are evaluation and our bodies react in threat when we go into doctor's offices.
What measures of neural regulation of any of your organs have you ever had?
There's no toolkit.
The closest thing is HRV.
And HRV, as it's being used, doesn't have the specificity, but it could.
And that's really what I'm saying.
We could develop better metrics of neural regulation and that will map into a lot of the symptom clusters that occur without end-organ damage.
So just to summarize, correct us if I'm way off base here, but what I'm hearing for people who are following along is that Autonomic issues could be sensed by analyzing voice and irregular regulation of body organs could also be sensed simply by analyzing voice.
Yeah, I think that's a good take-home, analyzing voice and face.
But I will tell you, very well attuned, trained therapists, whatever their discipline, know that from the get-go.
They look at a person's face and they listen to their voice.
And that's why I asked you about the people that you interviewed.
What were you picking up from them?
And the point is, you're probably picking up an awful lot.
You're spending hours interviewing people.
You're learning a lot about them.
You see their face.
You hear their voices.
Well, I think I even would like to take it one step further and also possibly back.
It's a little bit esoteric, but I am curious your take on this.
You know, one of the things that Jonathan and I are so interested in, and kind of from different perspectives, because obviously I'm trained as a neuroscience person and Jonathan is not trained as a neuroscience person
But when you talk to people who are, let's say, energy workers, or people who are healers, or Or, in particular, let's say, people who work in mind-body syndrome, right.
There's very skilled therapists who work in kind of the Dr Sarno kind of school of mind-body integration.
A lot of craniosacral therapists who do somatic experiencing.
We just had Peter Levine on.
So you know this notion that there are people who in many cases don't have formal training, but seemed to have some sort of intuitive sense of understanding.
And when Peter Levine talked to us about it, he talked about that there was on one side all of the male mathematicians and physicists who were talking about thermodynamics and a closed system and entropy, and that explains somatic experiencing.
And, on the other hand, were all of these female healers who who did not have any math or physics under their belt, but they were understanding people's experience from how they presented themselves, what their faces looked like, what their body posture was, how their voice was.
People even do this work in babies.
So I'm wondering if you can talk about both sides of it.
Are there people who are more in tune picking up these signs of someone else being in safety?
And are there people who are going to get better care from people who are tuned into them that way, as opposed to a classical Western doctor who's going to say, I don't know, blood work's fine must all be in your head.
Well, I don't need to answer that because you have already, you know, the answer on that.
So The point, of course, of this is, and I guess this is what I've done with my life.
I've bridged the very traditional, very laboratory-oriented scientists.
I've learned the language.
I perform within that with the critical behavior and expectancy of an aggressive academic.
I mean, I can play that role.
But I always love to step out.
I used to say what goes on before, anything after dinner I'll talk about.
But if you come to visit me in my lab, be respectful that my lab can't deal with some of these things.
So when people talk energy and stuff, I'm there listening.
But what I do is something different than many of my colleagues.
I listen to these people and I say can I extract principles and use a different language to explain it?
And what can I learn from it?
So the first thing we learn is it doesn't matter what discipline the person is in.
They can be helpful if they create a safe context or safe environment with their patient or with their client.
The body does the healing.
This is the first important part.
And this becomes the separation of our naive Western view of we think the healing is being done to us.
And that's why we take medicines.
That's why we have manipulations and surgeries.
Now our body is going to be differentially welcoming to any intervention, including nutrition, based upon the physiological state we're in.
So if we're in a state of threat, we're not an efficient metabolizer of useful materials.
So, when you have loving people, the bottom line is the first route of interaction is through co-regulation, in which there is a social interaction, in which our bodies feel safe with one another.
I love this.
I mean, I love your answer.
And I also love the openness you know that you have in this arena, because I think it's been sort of why your work is able to be applied in all the ways that it was or all the ways that it has been, you know, especially because you didn't start out as like, I'm going to study trauma and you know, I'm going to find out how the vagus nerve can modulate trauma.
Or was it Prader-Willi?
Listen, I was pulled into Prader-Willi.
And Prader-Willi is also very explainable.
A lot of the symptoms from a polyvagal perspective, including the weak suck, swallow and breathe reflex at birth or vocalize.
That's the social engagement system.
And you can hear it in their voices yet.
And the fact that they have auditory hypersensitivities and exhibit what might be called anxiety is just a reflection that their autonomic nervous system is locked into a state of threat.
So yeah, I mean, it's really, I would say, intellectually fun to move around, to start seeing how generalized principles are there.
All we have to do is literally drop our defenses and start seeing what's going on.
Yeah, it's been, for me, this remarkable journey.
And I have looked at from preterm babies and I even measured.
I did research in obstetrics as well as neonatology and autism.
And I've done animal work because I wanted to get at the mechanisms.
No, it's been kind of fun.
But I think the point you're getting at though, is not many people have that level of flexibility or the ability to enjoy challenging the existing knowledge of their disciplines.
And this is more of something that I've been reflecting on.
During the past, I'd say two years.
I'm trying to figure out in my own trajectory what would I have done differently?
And what surprises me?
And a couple of things surprise me in retrospect.
And that is literally the boldness of doing it.
Not the curiosity, but the boldness in the arenas that I was willing to step into.
So whenever I walked into a different discipline, whether it was anesthesiology or obstetrics or neonatology, I had to learn their vocabulary.
I didn't expect them to know my work.
I want to take a little bit of a journey just for people who may not know.
So there are, there are 12 cranial nerves, and you know nerves when you dissect them they, they can vary.
You know, sometimes they kind of basically look like dental floss, or they can be a little bit thicker.
But but basically there's there's 12 of these sets of nerves and they're for lack of a better word, under the brain.
Just, you know, that's kind of the easiest way to describe it.
That's almost insulting to a brain-centric person.
That is very true.
They're on the dorsal side of this.
Yeah.
So we have these 12 nerves, and many people have probably heard of the optic nerve, right?
Like, that's the nerve that's in charge of seeing, right?
I'm being very, you know, I'm kind of oversimplifying here.
And there's the olfactory nerve.
People have heard of the olfactory nerve, right?
So there's 12 of these.
And when you dissect a brain, you can see them all.
They're all distinct structures and some of them group together more around the the back of the brain again.
But the vagus nerve is number 10.
And you know these are things that we have to memorize in, you know, as undergrads and as grad students.
And you know, you learn.
There's one nerve that I remember the way I remembered it is.
It's the one that when I would get full migraines, that nerve would get activated and I would feel it from my nose to my lip, into my teeth and my chin.
So you know each of the nerves.
Basically, it subserves a different part of either the brain or the body.
But the vagus is special.
And it's special because of really what it touches and how.
So when you look at all of these different nerves, they don't look distinctively different.
Everything's the same color in the brain pretty much.
It doesn't look any different.
But can you tell us you, as the person who knows most intimately cranial nerve number 10, tell us what the vagus nerve, where it winds, what it touches and what that means?
Okay.
I'm going to emphasize the other part and really where it starts from.
So we have to think about the vagus as the mammalian vagus, as the product of an evolutionary journey.
And we can see this journey in embryology.
So in virtually every in other vertebrates, virtually every vertebrate, the vagus comes from only one area, a dorsal vagal nucleus.
And it It's unmyelinated primarily.
It regulates in humans.
It's still there.
It regulates the organs of the gut primarily, but it also has some input on the heart.
But what happens in embryology and in evolution is a subset of the cardio inhibitory fibers, the neurons that slow the heart through the vagus, go for a walk.
They go for a journey.
They go for an exploration.
And the exploration is now ventrally, where they meet up with the area of the brainstem that regulates the striated muscle of the face and head.
So it's like this very strange marriage between heart and face.
And this really is the trigger, from my perspective, of sociality.
That it's the understanding of the other person's state, physiological state, through voice and face, that enables us to come close to another individual without being defensive.
And also we know that there are people who lack the ability to detect facial information, basically information.
And those people have a very, very hard time connecting.
So just and I want you to continue on this journey of the Vegas, but I just want to kind of underscore this point that we have this nerve that is literally linked to what we would identify as gut feelings.
It also is linked to what we would say is our heart, right?
If you think about what it feels like in your heart and your, it is also dialed in to our ability to see.
Is this person safe or are they not?
Okay.
We're going to deconstruct what you said, because we have two areas of the brainstem from which the vagus comes from the dorsal and that goes to the gut in humans.
That's your gut feeling.
And that is the one that tends to be affected by trauma.
So much because the the body gets triggered not into a mammalian response but into a reptilian shutting down response.
And reptiles, when they're under great threat, they don't need to breathe for a couple hours.
They can just hunker down and wait.
Same.
But the ventral vagus is now the heartfelt vagus.
And it's really the connection between face and the heart.
Now, when you start to reach around your face, you are touching major areas of the trigeminal.
So the face, even though we think of it as the facial nerve controlling it.
The trigeminal has a lot to it as well, especially going into the jawbone.
We all know about the trigeminal from the dentist.
It's also a very thick nerve, the trigeminal, and also the trigeminal has interactions in the brainstem with the area that regulates the vagus of the heart, the ventral vagus.
So we start seeing that the cranial nerves that regulate the muscles of the face and head, including those that regulate the middle ear muscles that literally tense our eardrum, enable us to listen to social communication.
All that is wired together.
So you find out, like people on spectrum, there's auditory hypersensitivities, their eardrums.
They're not hearing human voice, but they're hearing noise, and noise is threat.
Their faces are flat.
Their voices are monotonic.
Their breathing is, and their heart rate variability is low.
You start seeing all these clusters coming together and you start saying well, it's not a diagnostic feature of a pathology.
It's a diagnostic feature of an organism in a state of threat.
This provides the optimistic perspective of what polyvagal theory brings to the table.
It says oh, you can have this.
But optimistically it can be quote, retuned or repurposed when the body gets signals of safety.
So I want to, as we're taking this journey with the Vegas, we've got gut feelings.
We've got heart feelings.
We've got the ability to understand.
Are you placing me in a situation where I'm going to feel safe with you?
And, in addition prosody, the ability to heal, hear someone's tone or to be dialed into what someone sounds like.
These are all very, very old skills that the brain has had to group together.
And it all happens with the vagus.
Yeah well, I want to kind of stop right there and remind you what you spent several years doing on it.
Was it NBC or where it was on the Big Bang Theory?
I watched that.
OK, so the role that you played in the role that Sheldon played were faces that were not animated, voices that didn't have intonation and all the consequences of that in the social interactions.
And the other part was that these are bodily feelings that would trigger others, but it didn't mean that your own images of what you wanted out of life were different than everyone else's.
See, that's the interesting part.
Even with people who suffer from severe trauma, their physiology is disrupted and their bodies aren't safe in the presence of another.
But it doesn't mean that their visualization, their dreams, aren't to be held comfortably welcoming, in the arms of another.
One of the really beautiful things that you talk about and this has been, you know, since your original polyvagal theory and is, in particular, talked about in our polyvagal world, which you wrote, I should add, with your son, Seth.
You bring up a really important point that I think especially for this generation.
You know of people who are getting information so quickly and they want to know like, what's the medical thing I'm supposed to do.
And can I click on it and give it to me in 15 seconds?
What you say about the vagus nerve is that the vagus is not telling you if you are safe.
It's telling you if you feel safe.
And those are two different things.
Can you talk a little bit about the difference between being safe and an objective perception of feeling safe?
Yeah, I think this is one of the major issues in our society is especially for those of us who basically, I would say, grew up during the Cold War.
So the notion of planes flying overhead were triggers of threat.
In a sense, we were scared that we would be bombed, even though there was no real reality.
At least we thought it was reality.
Okay.
So the difference is We live in a world that we think that removal of threat is our goal, is our responsibility.
I'm saying it's important to remove threat, but it's not sufficient.
So think about schools.
We put metal detectors or want to give guns to teachers.
It's going to be more triggering to the students because those aren't signals of safety.
So the way of conceptualizing is our body doesn't want to be injured.
So signals of threat are important to be ameliorated, but signals of safety are obligatory for our bodies to feel safe.
And we haven't even thought much in our society or schools or medical environments.
Or prisons.
Yeah.
Any of our institutions that signals of safety enable people to be more humane, more nicer smarter, healthier.
We just, we basically throw it back at the person and say, it's your responsibility.
We treat it as intentional as opposed to being reflexive to the signals in the culture that we're living in.
So I don't mean to compare schools and prisons, although it wouldn't be the first time I did so on this podcast.
I would give you another one.
I have described being a university professor for over 50 years as being in confinement.
And the issue is not that it wasn't good, not that it wasn't beneficial or wonderful, but it was extremely limiting on intellectual curiosity, creativity and exploration.
So it was extremely frustrating.
So I think of it as literally being in a prison, not necessarily being abused by the actions of the prison selectively, but it's an abusive environment.
Schools are medical environments, our society is functionally abusive.
We're all like nodding our heads in agreement over here.
But I mean one of the really special things about this book in particular.
I mean, you address each of those things in their own chapters.
You have a chapter about the workplace.
You have a chapter about schools.
You have a chapter about the prison system.
And the notion is what kind of behavior are we trying to produce from an institution that inherently is not helping people feel safe, even though you can check the boxes and say it's safe?
There's a metal detector, there's walls and no windows, right?
Like that's counterintuitive to the actual human experience which you're saying.
The Vegas is crying out to have that kind of safety.
Yeah.
Yeah.
Well, I even try.
So We created a not-for-profit called the Polyvagal Institute where we're trying to develop educational materials for schools, to create workshops, to make schools more quote polyvagal-informed meaning get kids out of states of threat and let them develop.
Likewise in medicine, we try to work in some clinics to literally change the interactional framework of how staff works with clients.
And we want to start with receptionists onward, not just physicians, but everyone who engages the patient.
Tell me how a receptionist can make me feel safe.
I'm being totally honest.
Let's just take that.
The first person you see when you walk into any kind of institution.
What are the things that make me feel safe?
What should the receptionist be doing?
I don't have to tell you.
By the intonation of your voice and the body posture.
You know what you'd like to see and you're not getting it.
That's what you're telling me.
I want someone to be pleasant.
Yeah.
Welcoming.
Let me use the right words.
Welcoming and accessible and engaging with you, that you are now the most important thing in that person's world at that moment.
And they need to make sure you feel that way.
As opposed to take a number, sit down, don't bother me now.
I mean, it's not that different than what you want in a relationship, right?
It is a relationship.
Right.
But the relationship is setting the stage for a healing process.
And the healing process will not occur in a body that's in a state of threat.
And what you're telling me is the engagement starts off as threatening.
And I'm telling you, you're absolutely correct.
And we've been trying to do this, and I'm trying to figure out what are the right venues for it.
And I finally decided, believe it or not, it doesn't fit.
My model of the world is high-end addiction treatment centers, because they can afford treatment, to invest in these types of relationships.
And I'm trying to build that in a couple of places and then make it scalable.
So we want to learn our lessons.
But I tried to work in a Medicare, Medicaid.
It was a Medicare Advantage type clinic which had a lot of people, burnout of staff and a lot of churn, with people dropping their system and everyone being very frightened and mobilized.
It was very difficult.
Okay, I mean, I have so many questions that are like specifically, so are polyvagal, world centric, but also there's so many other things that this encompasses.
You know, the...
I grew up in Kaiser.
Like I grew up, you know, my dad was a public school teacher.
And so we, you know, we had Kaiser coverage.
And this is not a general statement about Kaiser in general, but I will say that I grew up in, you know, a very kind of like factory organized medical system.
And there was not a lot of choices we had.
The new thing is there's not even a receptionist at Kaiser anymore.
You cannot call and get any information.
My mother still uses Kaiser.
There is no general number.
There's no general information if you have general questions.
It is such a complicated system.
But what I will say also is that for those of us who were not raised with money or resources—
That's the best health care that you get, meaning this is also a class system.
Like the vagus, nerve seems to also be preferentially cared for in situations where there are simply more resources.
Yeah, let's just stick on that because that's an important point.
So let's talk about a marginalized segment of a society and ask the question about their vagal regulation.
Their bodies are locked into states of threat.
They start getting what is often called psychosomatic or psychogenic illnesses, cardiovascular obesity, gut problems.
It's the consequence.
In a sense it's not okay.
I sit back and say we could be so informed and we could create much better systems.
Why don't we?
And we're always confronted with the bottom of the answer.
And people say, well, it costs money.
Capitalism.
Yes, but if this is done right, it saves money because people don't go in for medical care.
If they don't need it, they're healthier.
And actually when Kaiser started, it was that whole idea that it would save money because people would be managed better.
They were just managed incorrectly.
Well, it's because okay.
So it's like my interactions with the medical groups are really it's not the physicians, because they feel like they're being killed or stressed out, committing suicide, all these things.
They can't even practice medicine.
It's not even like they can't get any of the pleasure of delivering their service.
They're robbing from them is that interaction.
They sit in front of the computer and with electrical records and don't even look at their patients.
The patients feel disconnected and they feel disconnected and this is not what they signed up for.
Capitalism.
I think it all comes down to capitalism.
I want to touch a little bit more.
Before we get into some of the implications for trauma, which I think are really, really important to highlight, I want to touch one more second on the multiple modalities that are impacted by the vagus nerve.
So you mentioned literally your ear will tune differently if you don't feel safe.
So you will be, and this is your old animal brain, you are listening, again, I keep crying.
I'm very, very activated today in our episode, Dr. Porges.
You are tuning in to sounds of the equivalent of the roar of an animal.
You're listening for things that resonate at the frequency of predation.
Like that's what our brain Like we may think like oh, I drive a fancy car and I have an iPhone, but we are animals and
And our vagus nerve is literally saying if you don't feel safe, I'm going to have you listen for the things that your body needs to listen to.
If you're not safe, like the growling of an animal and not the loving voice of a friend.
Let's stick with this for a moment because there are a lot of consequences.
Language delays, testing poorly on vocabulary tests.
Auditory processing.
Yeah, being viewed as not being very smart.
And really, your body's in a state of protection.
It's not in a state that can afford to interact.
So we see these things occurring.
The body's adjusting. but it's not in the way that, let's say, education and our society wants.
And that's just one modality, right?
That's sound.
What about sensitivity to touch, to light, to emotional input?
Okay, so I developed a battery of sensory scales because I was asking that question.
And I had a simple theory, which was, Auditory hypersensitivity was at the root of everything.
When you're auditorily hypersensitive, you're tactically hypersensitive in your visual.
The empirical data tells you something that's a little different.
The empirical data says that, if I can calm your body and we did this with the safe and sound basically a music that was melodic like a mother's lullaby.
It's filtered, it's computer altered, and it's a neural exercise of processing those frequencies.
And it's really quite effective for auditory hypersensitivities.
And so what I wanted to see was what else changed with it.
So what changed with it was visual hypersensitivities.
And then I started to figure out, well, you know, Visual hypersensitivity is pupil dilation.
What is pupil constriction?
It's parasympathetic, it's cholinergic.
So if my sympathetic nervous is on high drive, my pupils are dilated and I'm visually hypersensitive.
And if my vagus starts going on, I calm down, the pupil starts to constrict.
Tactile hypersensitivity and what I found was the most interesting was ingestive pains disappear.
These problems and selective eating.
So this becomes- Wait, what?
Yeah.
Now think about selective eating.
So you have children, they may have had phases of only white teeth.
I'm the child with phases.
Okay.
Okay.
So you know what I mean?
Pizza, toasted cheese sandwich, cheese tacos.
It's all the same food group.
It's high fat.
It's fat and it's salt.
Yeah.
Yeah.
And your body craves it because it's calming.
It calms your gut.
It calms you down.
Comfort food.
It's comfort.
It closes off the pylorus, stabilizes the release of insulin.
Unless you're at Ashkenazi and then you can't process dairy.
That's a different story.
Not well, but you still try.
You have to eat ice cream.
Remember, that's part of the... Well, we're vegan, so it's like a whole thing.
Wait, so selective eating will change with regulation?
Yeah, so think about why.
Ingestion.
Selective eating is all about ingestion.
Ingestion is linked to the vagus.
It's the social engagement system.
Ingestion.
So when we talk about preterm babies, what's the first question to ask?
How did they develop their suck, swallow, breathe, and vocalize?
When you're dealing with Prader-Willi, what were the questions?
And what you find out, like with the Prader-Willi, is atypical suck, swallow.
It's there from the get-go.
Now, the question is, is that a characteristic that can be modified or are they locked with it?
And polyvagal theory says this is all a physiological state.
It can potentially be optimized.
And that actually was a project that I did want to do with Prader-Willi, which was to use the safe and sound protocol.
Anyway, the bottom line is, yeah, it touches these sensory systems and affects how we live our life.
So, going back to the book, we really say you know, our physiological state is that intervening variable that affects everything, our sensory experiences and our responses.
I have a funny question.
Well, it's not really funny.
I think it's a legitimate question.
And then I do want to move on to trauma.
Why do women like bad boys?
Why is there something about a motorcycle?
I guess it could be why do women like bad girls, too?
Why do men like bad boys?
It doesn't have to be gendered.
When someone's on a motorcycle and they look like they're not going to return your call.
Why is that attractive?
Because we know that it means like, oh, they must beat up all the other tough people.
They must have the.
Largest testicles.
I don't know.
But my vagus nerve should be telling me where's the nicest, gentlest person that seems like they could hold a job and also meet my needs, and maybe I could have an orgasm.
Okay, maybe you're talking through your parents' voices.
And I think that's the transgenerational voice that comes in saying, take care of my daughter.
Wait, but we want to be taken care of.
You don't want somebody who's going to not return your call.
But everybody likes that person on the motorcycle.
Not necessarily.
Okay, let's see.
I'll raise the cake by myself, Dr. Borges.
Okay, so no, that's not what I'm saying.
I'm saying there are phases in which certain experiences are welcome, but they're not necessarily phases in which you think about a permanent relationship.
So the bad boy may be, excitement may be things that you wouldn't experience in the normal trajectory of that parental voice in the back of your head and say well, let me just try this for a couple of nights to see what it is.
Or years or decades.
Yeah.
Well, I think there's literally a trick that occurs.
And you know that is.
I think experience is good, but we have to understand our physiological reactions during those experiences.
So there was a wonderful line in Steinfeld in which... Elaine?
Elaine?
Elaine and Jerry get back together and start building rules about how to spend the nights.
What was the rule?
Can't sleep over.
Now, sleeping over is now our bodies are now safe.
And that's with bonding.
That's where the oxytocin comes, safe in each other.
So they're in the recreational form of lovemaking and experience and not in the bonding form.
And so the point is that there's nothing wrong with a recreational form.
It's just not to be tricked into thinking that the recreational form leads to a bonding form.
Okay, but I have to ask the next question.
You come from a very different era than I come from.
And I come from already a completely different generation than my kids.
And I wasn't even 30 when I had my first kid.
Do you know what kids do these days?
They don't even bother with first, second, or third base.
Like fourth base is first base now.
Second base is like moving it together.
Third base is like divorce.
I don't know.
What does that mean that people also have shifted?
I mean, this is, as someone who studied oxytocin, this is a legitimate question I'm asking.
What does it mean when the timeframe and the scale on on which we base connections with other humans is so collapsed?
Like, what does that mean?
Like, my kid doesn't, his Vegas doesn't know if he's safe after one date, I promise.
Yeah, but I would say the real issue is the okay.
It's the transfer of play behavior to an object from people.
So the development of your kids meaning a lot of gaming on video and a lot of two-dimensional screens as opposed to playing and spending time together.
So what I'm really saying is the friendship socialization phase, the normal developmental phase of being comfortable, safe enough with another person, doesn't occur in the way that it used to.
So we violated what our body needs to, in a sense, be comfortable with another.
That's why they may accelerate the interaction They say it's no big deal.
Sorry, I'm like hung up on this.
They say it's just like it's not a big deal.
Like you just.
Oh, okay.
So let's say it's not a big deal.
Right.
But the issue is depending upon.
This is part of what I really wanted to go back to, like the Seinfeld episode.
Don't sleep over.
So it may not be a big deal, but then you have orgasm, you sleep over, the body becomes now coupled.
So you start getting into this.
And I talked about this in some of my talks.
You basically can't live with the person.
You can't live without them.
You're bonded.
You're physiologically bonded.
And I basically said that occurs when the social engagement, the friendships, is displaced with the molecular part.
So the oxytocin comes in before the social awareness and the features.
I like this person.
I like the features of them.
You know of her or you know you.
Basically it's your checklist, but it's not your checklist.
It's your visceral checklist.
I think we're making a pitch to slow down the dating process, but I don't think that everyone who's listening totally follows what the alternative should be.
No, I'm saying they should expand getting to know people, getting to know the features.
Relationship is, look, sex is important, but trusting a person is probably even more important.
And when you're young, you may not distinguish between the two.
And sometimes danger is attractive, right?
Like, I mean, I'm not a one night stand person, but I know some people are.
Some people say that there's something about that danger, that unfamiliarity, that is especially titillating.
Is that Vegas regulated as well?
Well, if you're okay, the involvement of the Vegas is really.
Perhaps the Vegas goes for partial break and allows the exuberance of the sympathetic nervous system to without going totally dormant.
So we have to think about what, okay, why do we like going on roller coasters?
Well, we- Some don't.
I do.
I do.
The issue is we can experience jumping out of a 10-story window without getting injured.
So we can have the exuberance, the exploration of those feelings, but in a safe enough environment.
Then our body can have all these things.
So In a way, relationships or even one-night stands, the expectancy is not to be physically injured.
And then so if they're quote safe people, then it's experiential, without the bonding that is a natural way of occurring.
So the work on oxytocin is really about, or voles, they bond, they're stuck to each other for life.
But in a way, human nervous systems bond too, and oxytocin plays a major role in that.
And the issue is you can be bonded to someone you don't like.
I want to follow this thread of immobilization because one of my favorite parts of the book.
You talk about a green system, a yellow system and a red system.
Right,
That we know when things are a go, we know when things are an absolute no-go.
And then there's something in the middle.
But you describe that there are many situations in our life where there's aspects and it calls to mind the beautiful kind of way that the Vegas twists, turns and connects.
There are certain situations that combine elements of all these different phases.
And sex you described as kind of a green and a red, because and you keep using the word immobilization
First of all, there is a I could use the word receptivity, accessibility of sex, if sex is going to be pleasant.
Now, if it's not going to be pleasant, It has different words we use for it.
But if it's a consensual, pleasant interaction, bodies become accessible to each other.
Now, to be accessible, the ventral vagus is on.
It doesn't mean it's always totally on.
It doesn't mean the sympathetics are off.
The sympathetics give you the sexual arousal.
That's a go.
That's like, yes.
Well, in part.
Maybe for you, but not necessarily for, because the male, guess what the male needs?
Hell if I know.
Well, the male needs a tremendous amount of vagal control for the erection to occur.
Wait, okay.
I'm trying to act like I'm not 12 years old right now.
Okay, that's why many men, or let's say young men, especially in their initial sexual interactions can't, can't do it and they're accused of being scared.
But really what it's about is that the vagus isn't there.
They, in a sense their body, is interpreting the environment much more as threat performance, threat or whatever, not as a moment of expression of a pleasure.
Now the interesting other part is, once ejaculation occurs for the male, The physiological state goes into kind of an immobilization state.
And that's a state involving a lot of the dorsal vagus as well.
And this is really, in a sense, when the dorsal vagus and the social engagement system, the heartfelt vagus, are on together, we have moments of intimacy.
So the sexual act is not necessarily the intimacy.
It is most likely after the sexual act. is the feelings of intimacy.
And that happens.
That doesn't happen for all mammals, but it in particular happens for primates, right.
And in particular, homo sapiens.
Yeah, well, we have to talk to Sue about that.
Right.
Well, like post-coital cuddling, we don't usually think of for prairie voles, you know?
It's not the first thing I think of.
I'll have to ask her.
So one of the most astounding and significant components of polyvagal theory has been its application to understanding, in particular, certain aspects of trauma.
And when you were a young student, The notion was this is a fight or flight system, right?
That we're either in a state of fight or we're in a state of flight.
And you were part of this real revolution that had tremendous implications, in particular, for victims of sexual assault.
And what you were able to articulate, which is now completely accepted, understood and even has been elaborated on, which I want to ask you about in a few minutes, is The notion that freezing is a third option that the mind and body take, that your choices are not always just fight or flight some people freeze and that immobilization was not seen as part of this system.
Can you explain what it was like to come up with freeze?
Yeah, we're going to create a distinction of different forms of immobilization.
One with muscle tone, which means sympathetics are involved, and that's freezing.
And one without muscle tone, we'll call that collapse or syncope or fainting.
It could be all these features or defecation or shutting down.
And we have to say, under life threat, what does an organism do?
Well, it might just shut down like the mouse in the jaws of a cat.
And it has advantages, but it can't stay shut down too long because it needs oxygen.
So it's a time limit.
What about humans?
Do humans totally shut down or not?
Well, I didn't know that, but I get tremendous amount of information from the field, from the world, from the world of trauma.
They tell me what their experiences have been.
So polyvagal theory was not deducted or extracted from narratives.
It was a theory that was described And then the community said, this is my narrative.
And what it did was.
It changed people's experience in the sense of themselves from thinking that they were one, unique and crazy, to seeing that their body was trying to do the best it could and starting to honor what the body did for them.
So we start seeing, let me kind of backtrack.
We have these three resources.
So think of the lights as resources and that we can mix them.
And as long as we mix them with the social engagement system, life is great.
We have play instead of fight flight, and we mobilize and we have intimacy as opposed to shutting down when we're in the arms of another.
Now, let's take away the primary regulation of the Ventral Vegas.
We still have options.
We can literally use the sympathetic and the dorsal vagus together and that gives us this immobilization freeze response.
And let's start thinking about really a potential ontogeny or development of sequelae.
Let's say the first time a person is, you like those words?
I do.
It's from my history as a developmental psychologist, which is really okay.
So the issue was, to begin with, Let's say that someone had this really horrible rape incident and they literally collapsed, passed out, and then they're in an abusive culture.
And so the next time they froze and then.
They're really in a really abusive culture.
And so this becomes a common situation, let's say, in some, let's say, incest within the family.
Then the person says their nervous system says, you know freezing, shutting down is potentially lethal or dangerous.
I'll fall and get hurt.
Not that that's the level of decision.
The nervous system is optimizing.
Freeze is metabolically costly.
But what happens if I just dissociate?
So I see dissociation as this really superb nuanced adaptation to a life threat situation that has the least consequence to the physiology.
And when we start seeing that way, we start seeing this remarkable nervous system that is literally trying to optimize survival.
One of the additions to this notion of fight, flight and freeze.
You talk about fawning and you talk about appeasement.
And I think there's even one more that's been added.
But can you talk about what those emotional concepts have anything to do with this?
How does that work?
Okay okay, so i have a colleague friend, her name is rebecca bailey and she she's a specialist dealing with the people have been abducted, and one of her patients was uh uh, jc dugart uh, who was abducted for 19 years as a 11 or 12 year old, and and she also knows elizabeth smart.
So the whole community she knows and they're very angry about stockholm syndrome, the term, And about a decade ago they came to me.
Rebecca and JC came to me and said you've got to help us because we – don't like the word Stockholm syndrome.
Jason was being accused of loving the guy.
She had all kinds of words for him.
But the point was that they needed a different word.
So I kind of ruminated on it for a while and they kept literally engaging me.
Finally, we wrote a paper last year.
It's published in the European Journal of Trauma or Traumatology.
And it really describes what appeasement is from a neurophysiological level.
It's hypothetical.
And the issue is it's a very remarkable nervous system that retains sufficient attributes of a social engagement system in a state of life threat and chronic fear to convince the predator that you're on his team.
And you start to figure this out and say, what a remarkable one.
But I said I have to be real careful because we're in a world where people think all this is intentional.
So someone who doesn't have the capacity or nervous system to appease, it's just not gonna work.
So we have to honor JC and the people who do that without having that expectation for another.
And now I'm thinking about this appeasement for my friends who are of, let's say, of diversity, because they are often having life experiences like that as well, on a chronic level.
And I'm very interested in that concept that you know they have remarkable nervous systems to quote fit in.
But are they really fitting in?
Are they getting all the benefits of the social interaction, or are they still under a degree of threat?
So I'm very interested in that.
Now the word fawning you put up.
Yes.
I describe appeasement as I'm important to you and fawning as you're important to me, meaning to keep that bond going.
Oh, I think fawning is asking to be killed.
That's how I interpret it.
Because you lose the value.
Once you fawn and I think this is clear from those who appease their nervous systems understood that they were still of interest and therefore being taken care of.
When you fawn, the interest disappears.
No longer the bad boy.
You see, it's like you lose importance.
Now, I don't like the word fawning, and it's not mine to use.
Now, I will tell you that I never used the word appeasement, until this past year or so.
Prior to the pandemic, I was talking in London, and someone asked me a question.
How would you explain the peaceman?
I said, I'll think about that.
Ask me in a couple of years.
And so we actually wrote a paper, but we are also writing a paper on fawning now, insane people.
And I think the restriction that they want on the word is Fawning has to do with the issue of consent, and that is part of what they want articulated.
They want to, because they're individuals who have been accused of fawning in these situations, and we have to have a great compassion for how these labels have been used to people who have been severely injured.
Can we describe what fawning is for someone who doesn't understand it?
For me again, the use of these terms appeasement to me, as I said, is a person who is, let's say, captured and is under life threat and things, but is presenting compassion to the individual who's a predator and is literally being welcomed into that predator's home.
And there's a degree of trust going on, a apparent degree.
You know, it's not deep, but it's enough to not get injured.
Now fawning from my perspective and I have to say this is me talking and not people who have other people abuse.
It is fawning, is just giving up, basically.
It's like saying, take me, I'm here.
That's it.
I'm not even going to play with you.
I'm just going to lay back.
Your book also deals with COVID in a really special way.
You talk about vulnerability and you talk about the differential impact of COVID on people who, in many cases, had complicated trauma histories and, And you know, the first thing I thought was like oh is this?
Because if you have trauma, you're not processing the uncertainty and the anxiety.
And then I kept reading.
And no, the.
The notion is that those who have a trauma history are not able to access the, the healing process, like the resources that the body has, as you said, to heal itself.
What does that mean?
What did you learn when you think about COVID from that lens?
What does that tell you about our society in general?
Our society is labeling people without understanding their history.
So it assumes it takes a worldview that if we have a physiological characteristic, it's ours for life.
It doesn't acknowledge that there's a lot of retuning or repurposing of our autonomic nervous system.
This goes back to what I started in the beginning, stimulus organismic state response.
What we learned during and I did research during COVID with people both who figuring out who got the disease, as well as those who didn't get it and had symptoms from the pandemic.
Basically, if you have an adversity history, you are going to be more likely to have gotten COVID on the initial wave of it.
But another way of viewing it, because when you go deeper into the data.
That's deep already.
I mean, just that.
It's not deep enough.
It's not deep enough, but it's deep.
Well, yes.
So adversity history is a pre-existing condition of vulnerability to the illness.
But here is where it gets really, I would say, neurophysiologically interesting.
It's the strong pathway to outcome is really not from trauma to outcome, but trauma through autonomic state to outcome, the intervening variable.
So if you have a trauma history and your autonomic nervous system is retuned to be in a state of threat, forget it.
You had depression, anxiety, even if you weren't infected, you had worry.
The interesting part for me was when I started looking at.
We did a study with 2000 people in the first.
This is spring of 2020.
It was a survey scale online.
And in that, of those 2,000, 100 had had COVID.
And we excluded them from the first paper.
And we were talking merely about the mental health symptoms of being in a pandemic.
And that was predicted by their trauma history and their self-reported autonomic state.
But if we looked at those who got COVID those 100 none of those were people who had low ACEs or low adversity scores.
None of them.
So the people with low adversity didn't get COVID in that subset I had.
But if they had a high adversity score, 75% got COVID.
So the issue is we confuse this.
So what became in the medical or public health arena, pre-existing conditions was a buzzword.
You know what it really meant to the medical community?
What?
Obesity.
Yeah.
Now, again, the link between obesity and trauma is quite high.
And that was literally discovered by a physician at Kaiser.
I mean, I'm not trying to be funny, but like comfort food, right?
Comfort food, it's more than that.
Of course, but that's the first thing I thought of.
We eat our feelings, right?
No, think one step.
We change the regulatory system.
When we're under life threat, we are in a literally... a conservation mode.
So we retain, our metabolic strategies change.
So we don't need to take food in to get fat.
That's what Folletti at Kaiser figured out.
People were gaining weight in the trauma world.
They were just gaining weight.
He couldn't believe it.
Well, and then you add food deserts, you add the socioeconomic pressure, you add the lack of access to healthy whole foods, you add companies that give you toys with the food that is going to cause you cardiovascular disease, and then they will have the clown visit you in the hospital.
So you need to invite Rob Lustig.
Have you met Rob Lustig?
Okay, you need to invite him because he will get you really worked up.
But he's an endocrinologist at UCSF.
But what he did, he got a degree in law so he could fight the food industry.
So he's extremely serious about all this.
I want to ask about a book that was brought to Jonathan and my attention by George Bonanno.
It's called The End of Trauma.
And, you know, I'm going to paraphrase and it already kind of makes it catch in my throat.
You know, the notion is that like, we're more resilient than we think.
And all everybody's saying that they're traumatized and we're really fine.
And we didn't get here from you know being so delicate, you know, and I'm really like a I'm a Bessel van der Kolk person.
I'm a like the body keeps the score.
I swear every part of my body keeps the score.
But I wonder, you kind of accidentally have become this incredibly important figure in the world of trauma for so many of us.
What's your response to that?
What do you really think is happening when the body's processing trauma?
Okay, so what I say is we're a traumatized species.
That's where I start off with.
And that's really what he's saying.
Yeah, we're a traumatized species.
We're flexible, adaptive, but we're a traumatized species.
The question really is can we use our big brain to create a structure to enable us to share our gifts, which is that of sociality and co-regulation?
So can we claim our evolutionary heritage?
Which is a totally different question.
He's really saying, you'll survive.
And I say, fine, we'll survive.
But I'm really a person who's on this planet thinking about optimizing the experience of being here.
And people aren't going to be clicking on trauma's not real the way they're clicking on your vagus nerve.
Well, I think, what again?
My son Seth, who's really a brilliant communicator, and he gave his father the greatest gift the son can give his father.
I can't say that to his brother, but...
His brother is the neuroscientist, so this is kind of the paradoxical thing.
And he studies the vagus as well, amongst other things.
But Seth did something for me that was so important, and that is to literally take my words and put them into his words to, in a sense, make it accessible.
So Seth is a communicator.
He's an orator.
He's a filmmaker and he was able to take something that – I'm a scientist at heart and I gravitate towards complexity.
Even though I can spit out a couple sentences here and there he just – he deconstructs whatever I'm saying.
So if he were here with me, he'd basically say, I'll take it from here, Dad.
Right.
So talk a little bit about why you wrote this book with Seth, with your son, who also is a documentary filmmaker and a really, really fascinating communicator.
Otherwise,
Oh, he's amazing.
You need to see Class Action Park, which is on Max.
Then you'll get a sense of who he is and his creativity.
And he has a film coming out on Netflix.
So I did it with Seth because he he volunteered as a dad.
I mean, let me tell you how what I call the razor's edge or the tightrope that we walk as dads.
I would never ask him to do it.
I was like, I am here for him.
He doesn't have to be here for me.
That's, in a sense, the oath I took for my kids.
And that's my role.
And he wanted to do it.
And the fact that he wanted to do it, I mean, it was just wonderful.
And so... Well, it also makes it really enjoyable.
You're...
You're a very playful writer.
And so I really enjoyed the times in the book where you would indicate which was his voice or which was your voice.
It's a very enjoyable read.
Before we let you go, Peter Levine referred to you as his brother from another mother.
And I have to ask you, do you even like this guy?
Oh, yeah.
Oh, yeah.
I would say you mentioned two of my brothers, Peter and Bessel.
And I what I often say is this is their day job.
This is my hobby.
And so they're both of them are remarkable people who basically brought me.
Actually, there's a third person, Pat Ogden.
I don't know if you know of her.
The three people who brought me into the world of trauma welcomed me into their world.
With I mean welcome, welcome with parity and insight and love.
And it's been a remarkable journey.
I really, yes, they're both of them I view as my brothers from different mothers.
And it's interesting, I've known Peter from the late 1970s, when these ideas were percolating in.
This very strange guy used to call me up and ask me things and would fly out and come to wherever I was living.
And that brought me into the West Coast world of Esalen and other things.
And I thought of Rolfing.
I thought these were really kind of interesting for a guy that lived in a laboratory.
You know, Bessel, you know, Bessel really...
Trauma is, Bessel put a spotlight, a headlight on it.
And it wasn't easy.
It was really costly to him in terms of an academic career.
And that part I find really interesting.
So always, like we have dinner, I say, Bessel, you've done things I couldn't do.
And he looks at me and says, of course, Steve, you would have done the same thing.
I said, no.
I said, there's a degree of being pragmatic.
I'm concerned about my family.
And I realized that my role in life was to leverage what I had.
So as a scientist in a sense an accepted scientist I can leverage my credentials, the work I've done to venture into these areas that none of my colleagues would.
So I'm really pretty much out there in terms of this clinical world because most of my colleagues don't literally know enough about it, because they're not interested enough to be literally mentored.
So Peter and Bessel were my mentors.
Well, it's really, it's so phenomenal to get to speak to you.
And, you know, it's really rounding out this whole field for us in such a beautiful way.
Before we let you go, if you had to leave us with, what can we do to increase our sense of safety in our society?
What would your top three things be?
Well, I'd say the top one is understand that our evolutionary heritage is to mitigate threat through co-regulation with another trusted individual.
So it's like I'm going to use the metaphor feel safe enough to be held in the arms of another, and either another human being.
And if that doesn't work for you, I'll point you back to my cat who's sleeping on my chair.
But the point we really know is that those who don't feel safe enough to be in the physical proximity of another often will get a social mammal, so they'll use their dog, cat or horse.
They'll tell you what they're doing.
They're feeling safe enough with another.
So the take-home is that we don't need to hack the vegas with electrical stimulator, or even humming's not bad, but we don't need to do that.
We need to be in the presence of others that we trust And when we learn from the world of trauma, the people who have survived trauma teach us about what it is to be human by teaching us what they've lost.
And they've lost the ability to feel safe enough with another.
And that is penetrating.
It's not that they don't want to be in the arms of another.
Their bodies don't feel safe enough to be in the arms of another.
And once you understand that, you understand how to interact.
And I've had these kind of amazing interactions at meetings where people will come up to me and say you know, I'm aces of eight or whatever they wanted, basically saying really horrible history.
And I'll look at them and say, you know, you're looking good.
Would you like a hug?
And they'll see me as an accessible male.
And I will give them a hug and I'll get emails back that say things like this.
You're the first male that allowed to hug me in 20 years.
And so what that taught me was there's literally an archetype that's locked into our minds that who is safe enough?
And if I play that role for others, you know, it's what a privileged role to play.
Now, we all have our own weaknesses, but we It's also the fact that my presence to them has a therapeutic component to it as well.
Stephen Porges, it's been such a pleasure to talk to you.
The book that you wrote with Seth Porges, Our Polyvagal World, How Safety and Trauma Change Us.
Really such a pleasure to talk to you, and please send our best to your whole family and in particular, to the person who's in my thesis more than I am.
I will, I will.
She's wanting to make sure I said hello for her.
Here's my question.
Is my voice communicating that I am safe?
You mean, is your voice communicating to other people that you're safe?
Or is your voice communicating that you feel safe?
Because that's two different things.
No, it's the same thing.
No, because someone's voice could be like, I'm safe.
But then when you hear their voice, you're like, no, you're not.
You may feel safe for yourself, but I don't feel safe around you.
Not the words.
I'm saying the tone of my voice.
The Canadian lilt?
It's very comforting.
When I speak like this, I might say, when I speak like this, sometimes I feel like my voice is caught a little bit in my throat.
Is that because I'm not safe in those moments?
It is caught right now.
I think Dr. Porges gave me a lot more credit for many things than I deserve.
He was basically giving me a PhD in clinical psychology.
It's because you just like to remind everyone that you have a doctor.
No.
I was just like, oh, how do you know if you feel safe?
And he's like, well, Mayim, I think you know if you feel safe.
You're like, no, that's why we have you here.
If I knew when I felt safe, I wouldn't have made all the bad decisions I've made.
I also like I wanted to ask him so many silly questions like, like Dr Porges, does my cut out turtleneck make you feel safe?
Dr. Porges, does my pointy chin make you feel safe?
Dr. Porges, does the fact that I sound like Harvey Fierstein make you feel safe?
Your motorcycle question was pretty good.
I like that.
I really liked him.
I really, really like this person because he's I love all of the fields that he has a hand in, because I think to me it's like he's the perfect example of what I think the medical field needs more of, just conceptually.
Like, people who are open to speaking different languages.
Or what did he say?
He's like, you know, after dinner, we can talk about energy work, but, like, if you come into my lab, like, we speak the language that we speak in my lab, you know?
But his book talks literally about politicians who use a tone... that is designed to scare you.
That is part of what this book is.
This book is taking the polyvagal theory and applying it to all the practical situations that we encounter.
As we talked about, schools, prisons, you know, medical facilities, work.
But he talks a lot about what.
Does it mean that we live in a culture where many politicians, on both sides of whatever middle there used to be, use fear to make you vote one way or another?
The notion that there are external cues that can happen in a hospital setting, that can happen in the interaction between a nurse or a receptionist, that is priming the body to be able to heal or not, and that we don't have access to our ability to heal until we feel safe and that that is not a factor considered.
In our medical approach.
Like you, could do the exact same thing, feel safe and have one type of outcome, and then not feel safe, do the exact procedure and have a different type of outcome.
That is a massive, massive variation.
The best example that I can think of is birth.
It always comes back to the way that humans literally enter the world outside of their mother's womb, because
Traditionally historically, midwifery woman to woman support was the way that women learned about their bodies and learned to push a baby out.
And I know people are like, but people died.
Yes, people died.
But this is we can't collapse all points into one.
When, when birth was westernized, when birth was placed into the category of a sickness, an ailment that is to be managed, and it was moved from midwifery centers into a hospital setting, what happens?
Bright lights, big city.
And birth becomes the subject.
You become the subject of a medical system telling you how to birth your baby.
And of course, there are certain things we're so grateful for, like C-sections or Lifesavers.
I'm not saying that they're not.
But what birthing centers have started to do in the last...
20 years.
More generally, and what midwives have known for thousands of years, is that women give birth when they feel safe most effectively, efficiently and safely for the mother and the child.
This is a great example.
So what do birthing centers do?
They make it feel like home.
They tell your vagus nerve, bring your candle.
Bring smells that you like.
If you need a sip of water, take a sip of water.
We're going to lower the lights because mammals usually give birth in the middle of the night, because that's when it's safest and no one sees that you're pushing, and they're not going to steal your baby as it leaves your body.
So they make it feel safe.
And when you feel safe, your body opens up and releases the baby.
Why do I know this?
Because I did it.
And when you feel anxious, guess what part of you tightens up, people?
Your tushy and your uterus and your cervix.
And when you have a tight cervix, you know what doesn't happen?
The baby won't come out.
What other examples do we have other than babies?
Well, really any surgical procedure.
You know and, and obviously in the name of hygiene, there are certain things we need to do in hospital settings.
But, like you know, when you see kids in the hospital, like God forbid, when you see kids in the hospital, what do they let kids do?
Bring a lovey.
Let them be in their PJs.
Let them hear things that make them happy.
Let them feel good.
Why is it different for adults?
I want to be in my PJs if I have to be in the hospital.
And you know who gets to do that?
Rich people.
Rich people who pay money to go to fancy recovery centers get to wear whatever the fuck pajamas they want when they're healing.
And everybody else has to be in that robe with their tushy out.
And that doesn't feel safe.
Doesn't feel safe to have your tushy out.
Also, the lights in hospitals are extreme.
You can't sleep because of all the noise and the beeping and people just coming in and out.
Look, I'm not a hospital designer or administrator.
There's obviously natural or there's a lot of reasons why things are the way they are.
People have to be monitored.
But even the lighting, even... the level of noise that happens could easily be mitigated.
And to know that the body will heal differently under those different conditions is so important and not tracked or understood by our current system.
I mean, I love that he said that.
Dr. Stephen Porter just said it.
The body heals itself.
It's not the stimulation you're giving the vagus nerve.
It's not the hacking.
Like, that's not what you need to click on.
Like, what does it mean to feel safe?
Who are safe people?
Trust your gut.
Trust your heart.
Don't get on that motorcycle with that bad boy or girl.
I know those girls.
They're motorcycle boots. shaved heads, just like the underside shaved.
Also what he said about not being able to metabolize the nutrition that you may be getting if you don't feel safe that your body is actually not going to do the work, no matter what stimuli or what resources it's given.
If you can't actually utilize the resources, that's the first stumbling block.
I mean, I thought about friends of mine with IBS.
I thought about friends of mine with Crohn's disease also, which obviously Crohn's is genetic and there are things that we know, but in terms of how we treat things like Crohn's, how we treat things like IBS, how we treat even colitis, there are certain ways that the body also needs to have support to be able to heal.
And those people were dismissed as crazy.
They were told it's all in your head.
Oh, you're just stressed out.
Figure it out, right?
That's the body saying like, I need help.
When he was talking about all the different modalities that are impacted.
And how all of those things fall under a general umbrella of a lack of kind of like physiological safety.
That's fascinating to me.
Think of all the things that impacts, you know, auditory perception, learning.
Touch, memory, and athletics.
I mean, it might even impact how you hold art supplies.
You know, like, you may not like clay, right?
You may not like the activities that your classmates are doing, and nobody will know why and you'll just be called weird.
If you've been called weird, but it's really that you didn't feel safe, we'd like to know about it.
I think that might be a lot of people's experience.
And...
There's a whole variety of reasons.
People are like, well, of course I should have felt safe.
My family had this type of house or my parents had this type of job.
But why we feel safe or not is quite a subjective experience.
I'm also wondering about people who are like, I'm fine.
I feel safe.
But have you ever met those people?
And everything about their body language and their voice indicates like I don't think you feel safe.
And they don't know.
Highly defended people.
I'm thinking of someone in particular who I knew who was such a defended person.
I don't mean defensive, just defended.
Like you couldn't get close.
You could like if you ask something deep, nope, everything's fine.
And like it was a it was always like that.
And when I think about what this person's home life was like, it was terrifying.
It's terrifying.
But that was that, you know, that's a coping mechanism that some people adopt, right?
I'm fine.
Everything's fine.
It's a survival strategy.
Maybe someday you and your son will write a book.
That would be awesome.
Although I think I'll be doing the writing and he'll be doing the playing video games.
That's a part of writing a book, right?
Yeah.
Well, we've now had on two of the brothers from another mother, Bessel van der Kolk.
We're coming for you.
Can I just eat my oranges and wait for that one?
I don't feel safe when you eat your oranges.
What's the need underneath that feeling?
I don't know.
From our breakdown to the one we hope you never have.
We'll see you next time.
It's My Ambionics Breakdown.
She's going to break it down for you.
She's got a neuroscience PhD or two.
And now she's going to break down.
It's a breakdown.
She's going to break it down.
