‘Our nervous system is always trying to figure out a way for us to survive, to be safe’

Stephen Porges is Distinguished University Scientist at Indiana University, where he is the founding director of the Traumatic Stress Research Consortium. He is Professor of Psychiatry at the University of North Carolina and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. In 1994 he proposed the Polyvagal Theory, which links the evolution of the mammalian autonomic nervous system to social behaviour and emphasises the importance of physiological state in the expression of behavioural problems and psychiatric disorders.

Kal Kseib is a chartered psychologist who supports leaders in fostering emotional wellbeing within the workplace. His interest in the mind-body connection has led to interviews with founders of some of the foremost psychotherapeutic approaches today. He holds a doctorate and masters in health psychology from City, University of London.

Read Kal's other interviews for The Psychologist.

What has studying trauma taught you?

Trauma has taught me what it is to be human. You can see with such clarity what trauma takes away from the human experience. A person can be gregarious, co-regulatory, happy and optimistic one day, and then something happens and you stop seeing these features. There's a shift in autonomic state, which is frequently accompanied with an array of medical co-morbidities. The autonomic system no longer appropriately manages the organs, becoming functionally dysautonomic. This is predictable when the nervous system is in a state of threat – a state in which it can't properly manage social relationships and it can't manage the healthy regulation of bodily organs. Priorities change from sociality and health, growth and restoration to the here-and-now – survival.

What does a polyvagal-informed approach to trauma look like?

It begins with understanding that our nervous system is always trying to figure out a way for us to survive, meaning to be safe. It's negotiating and navigating within this world. Our body, more specifically our nervous system, has circuits that are geared to help us survive even without our awareness or intentions. Sometimes survival requires a hypersensitivity to cues that may be dangerous or life-threatening, and sometimes it may require a numbing of one's own bodily feelings. We shut down, or we freeze, or we dissociate.

These strategies are adaptive. This means that they're not good or bad but serve, at least initially, a survival-related purpose. The body is enabling the person to not repeat the horrible events they once experienced. It's just taking good care of you. It's the body's way of saying 'we're not going there again'. Dissociation, for instance, is common among individuals who have severe trauma histories and can often be severely pathological, but we can also reframe it to be about the wisdom of the body. These strategies stay functional if they're used for short periods of time. But when they become chronic mental health is challenged and often diagnostic features of mental and physical illness are expressed – there's no differentiation between our mental state and our physiological state.

From a polyvagal perspective, what can we do to heal in the face of trauma?

We've come to think about trauma as being causal of other issues, whereas we need to think about it in terms of a re-tuning of the nervous system. Trauma is not the event itself, it's our body's reaction to the event. For individuals with trauma histories, it's not about 'ooh I have an insight, now I've figured it out'. That's off the table. Because trauma gets in the body the real question becomes 'how do I give my body a sense of meaning?' And that's what therapy is all about.

"we need to think about it in terms of a re-tuning of the nervous system"

Treatment is about giving the nervous system the cues of safety so that it re-tunes itself to being more homeostatic. And when it does that you increase co-regulation with others – you start getting a more optimistic perspective of life and you start seeing the core of humanity expressing itself. Optimistically, that core of humanity is amazingly positive… even among those who are severely compromised by trauma histories, you find that they still have dreams. What are their dreams? To feel safe in the arms of another.

And so ultimately our nervous system needs safe and nurturing relationships.

Being connected is a biological imperative of our species. We can think of it in a very simple way. What is the worst punishment that you can do to a person? Isolation. Solitary confinement. Being buried alive. All of these metaphors evoke terror because our nervous system requires the co-regulation of another safe individual. Our social engagement system – the ventral vagal pathway – is the neural circuit that is involved in detecting and responding to cues of safety that empowers our body to immobilise without fear. We're such an adaptive and flexible species that can survive severe life challenges, but we need to have the friendships, the love, the support and the care – moments of co-regulation and safety – for at least some of the time. No-one likes to feel marginalised.

It seems like those safe relationships may be in short supply at the moment.

The optimistic aspect is that the core of humanity is a core of empathy and compassion and co-regulation, but only if it's not in a state of threat. When you're not in states of threat you're open to dialogue and relationships with others. If our bodies move into states of threat – meaning our nervous system is in a state of threat – our ability to be compassionate, to be co-regulatory with others, just disappears. So does our ability to be appropriately future-oriented in the moment and in thinking about a helpful response.

People are also more prone to getting manipulated in states of threat. We think that arguments are easily accomplished by presentation of evidence but we forget that when people are angry or feel threatened, they're not even looking at the evidence. Critics, for instance, are not well co-regulated – they're angry. They react not because they're haters but because they're angry. And their anger basically impedes their understanding, learning or listening.

Well, that explains a lot.

You saw it happening with the Covid-19 vaccinations. There was this degree of self-defeating stupidity through anger and threat. The vaccines were and are, if we can use the term, a godsend – they're a miracle. They're really effective, more so than any vaccinations that have ever been produced, and they're flexible, meaning they can be modified. There was a way out. Why weren't more people getting vaccinated? It's because there was this idea that someone was telling you what to do and that it's a violation of your personal rights. The messaging was 'you're being abused and we need to fight back'. In part the poor messaging of public health agencies created a vacuum since many never processed a message that being vaccinated had to do with mutual responsibility, to other and community.

How does society and culture influence our capacity to feel safe?

We know that the underlying phenotype of humanity is to be co-regulatory but in our culture we haven't respected that need, that biological imperative. We have functionally interfered with it by creating a hostile, competitive, survival-oriented world. The bottom line is that most cultures are traumatised, although it's not frequently acknowledged. The British culture, for instance, is known for the 'stiff upper lip' where it's considered appropriate not to respond to your bodily feelings. But, of course, it's not just the British. My father, whose family came from central Europe, had some of these same features. To him it was about how you presented yourself, not about what's really going on inside of you. Survivors of war are another example. There's a great price to pay in terms of how people relate to each other when they return home and in terms of how they regulate their own bodies.

Why, as a society, do we tend to be so out of tune with our bodies?

The awareness of bodily state is something that we have kind of messed up in our culture because, if anything, we've taught the body – our nervous system – to be numb, not to be aware of our bodily needs, to sit still. We tend to shame people who listen to their body. If you listened to the culture it says 'block your feelings' and teaches us that safety is resource-based rather than relationship-based, meaning that if you have more resources, you're safe. As you get older you realise that 'accomplished' individuals who have resources without relationships are frequently the least fulfilled people that you'll ever meet. I've been watching Succession – it's a re-education for me to remind me that there are people for whom the laws don't matter and for whom money can solve everything, but who are the most miserable people in the world. They have nice jewellery, nice homes, private jets – all this stuff. And you've got to ask the question, what is it all for? What keeps them alive? And the answer is it's the need for power. It's not about relationships. They don't truly support each other or anyone. They're all, so to speak, 'bad' people because they don't have trust.

"we've taught the body – our nervous system – to be numb, not to be aware of our bodily needs, to sit still. We tend to shame people who listen to their body." 

So, what's the antidote – how can we shift the culture from one of threat to one of safety?

The solution is inclusion, but there's often a fear of inclusion. Once we understand that the nervous system can be optimistically and appropriately optimised or re-tuned with cues of safety then we realise the importance of social connectedness – sociality. We invest resources in giving people injections or electrical stimulation, but forget that sociality is functionally a neural stimulator. And we have to elevate this part of our evolutionary history when our social interaction became nourishment for our nervous system.

And at an individual level, where do we start?

I talk a lot about co-regulation – regulating each other's physiology – but we also think about the co-regulation within our own body and, in a way, how we often try to sever that relationship. If you think about it, what is it to be angry at your body? When we have health concerns, for instance – it's to say 'don't do what you're doing', it's to turn yourself off. In contrast, personal mental and physical health requires our nervous system to foster communication between the brain and the body. Everything becomes about respecting what our own nervous system has been doing and about not supporting states of defence by being angry at your body. This enables us to 'self' witness and understand, respect and honour the strategies that our nervous system is employing to keep us safe – at least in the short term.

The real critical point of being self-compassionate is how we support our capacity to be present to experience and functionally witness our emotional dimension. It's as if we are saying to ourselves 'I'm here', 'I'm present', 'I'm listening'. It's about respecting our body when our nervous system is conveying feelings to our consciousness. Several years ago I had severe pneumonia and my illness resulted in chronic fatigue for many months. I had to listen to my body to manage my health while working – matching my limited energy with my workload. What most people tend to do is turn off the feedback loops and try to keep going – they numb out. Instead, we talk about developing ways to manipulate our bodily state. Ways that enable us to move into states of mobilisation to work, and also into states of supporting sociality, calmness and relaxation to recover.

Interestingly a similar sequence of dynamically moving from mobilization to sociality are the features that define play. Clinicians often note that people with trauma histories and/or chronic illness lose touch with their capacity for play. When we start to listen to and honour our nervous system, we lose feelings of shame – we respect the brilliance of our nervous system as successfully navigating through complex environments.

'Losing feelings of shame' seems like a critical point.

When we get into the mental health world, we tend to say 'oh I would do fine under those situations', which translates as 'it's your fault'. And we can't make those judgements because we're not in the other person's skin – we don't have their nervous system and we don't have their history. Some people have an autonomic nervous system re-tuned to threat from experiences that many people wouldn't see as threatening. An event can have a high valence – a lot of power – meaning in retrospect you can talk about it and say 'well that was really nothing' or even laugh about it, but that's not how the body remembers it. Someone, for instance, may experience public humiliation – a very visceral reaction that can change them. Feelings in these scenarios can be deep and powerful and can reflect multiple situations of loss of control and loss of agency. Others might experience the same scenario and say 'oh that's a valid criticism' and they move on. Not that it's a cognitive decision – the body just didn't interpret it as a life-threatening situation. The issue is that due to the individual's specific personal history, their nervous system may have been retuned to be threat biased.

How can people feel safe within organisations and systems that demand much of them?

In the medical community self-care and self-compassion gets put on the side. They're seen as voluntary or even irrelevant – certainly not obligatory. Without self-compassion and self-care what clinical staff end up doing is depleting their resource. When people ask me 'how can you deal with this in the hospital settings?' my answer is 'peer group'. You have to have time to sit together, you have to have breaks, you have to have the socialisation process of the co-regulation among the team or 'clusters'. It's also about asking self-reflective questions such as – 'am I nourished by my work as a caregiver or is it depleting me?' And if it's depleting, then respecting the need for self-care.

Difficult to model in demanding healthcare settings.

Well, it's because medicine has become a business and the staff have become a resource for that business. It's functionally a mechanical model where everyone is dispensable – you have one person and you replace them with another. Humans don't function well that way. 

How can we improve the situation?

One project I'm involved in re-trains physicians to become more polyvagal-informed.

It builds their understanding that the way they interact with their patients affects not only their patients' health, but also their own health. Essentially, it's about physicians helping their patients to develop strategies that recruit the nervous system as a collaborator in the journey of healing, rather than scaring them. I'm also part of a think-tank with several frustrated physicians who have quit medicine and with research physicians in medical schools to try and help shift the educational model of physicians towards making it more polyvagal-informed. 

How would you guide someone who is struggling with a relationship?

I'm not a therapist but I try to give hints. I do things like say 'just listen. Just listen for a moment. Witness what the other person is saying. Don't create a justification. Just listen.'

Then before you go and develop the narrative about what the other person is doing, ask questions like, 'how is my body feeling?' 'What do I feel inside my body?' And if your body is tensing up, ask 'how can my body relax?' Are there breath patterns or mental visualizations I can use?' 'Can I venture out?' Honour your body's reaction, learn what your body is doing and don't create a reason for your body to react. If you can do that you then you become more embodied and more respectful of what your body is doing.

So the key message, again, is about respecting the body's reaction.

The notion is to respect where you are and also to respect what the other person is doing before you take on a narrative that justifies whatever you do – your reactions. It's not easy, it requires both being an observer and a participant – the ability to understand that how we react to others affects how they feel and how we feel. In the case of partners or spouses sometimes they just start yelling at each other because their bodies have shifted state. And it's very hard to tell another person, 'Look, this is what you did, and it disrupted me' because part of that disengagement is their adaptive strategy and now, you're blaming them for their strategies, so it creates a cycle – who do you listen to?

It's a lot to try and get right.

Look, we're humans which means we have great limitations. Simply knowing that we're all human and that this is the human response isn't the answer. We have vulnerabilities and we are going to be greatly affected by those around us who are in pain or who are disrupted. And the issue is what resource do we have to be present without being evaluative and defensive? It's not an easy journey. That's why I feel much more comfortable in talking about it than doing it. I can see the process and I use terms like 'super co-regulators' – people whose presence is so special that you just give up your defences. The best most of us can hope for is to be a 'good enough' co-regulator. 

"what resource do we have to be present without being evaluative and defensive?"

What does success mean to you?

The real question of course is 'what do you mean by success?' We make attributions that because people are financially successful or professionally successful, they are secure within themselves. I think it's a real fallacy because the world that we're in – whether we talk about academics, business, any form of educational model or even in medicine – is not about nurturing the resource of the staff it's all about bottom line, which means dollars. Even universities are all about how much grant money you can bring in. In hospitals it's the same story – it's about dollars, insurance money and grants. The majority aren't asking 'What is the journey that we're all on?' The journey of understanding what it is to be a human and understanding what it to make humanity a more comfortable, if not safe, place. To feel safer, to feel affinity and understanding – these are significant measures of success that aren't as valued because they don't pay.

What do you look forward to 'post-pandemic' – if such a thing exists?

What I miss with this new world is the social interactions that come from proximity. It's nice to be accessible as a human being. One of the things that academics are not so good at is being accessible to other people. Typically, they are defensive and self-protected and that means that their accessibility becomes an impossibility, a vulnerability or a distraction. And there is so much social nourishment in being accessible. So, if you can get that and feel it through giving talks it's extremely nourishing. That I miss.